“After all, I have to think for myself”: A qualitative study into the perspectives of clients on shared decision-making as a method to support return to work.

Abstract

Background: Work participation is an important determinant of public health; being unemployed leads to a decline in an individual’s health. In the Netherlands, unemployed people can apply for a disability benefit and receive support from reintegration professionals to return to work (RTW). Since RTW has a significant impact on a client’s life, clients should be involved in the decision-making process of RTW. A method to include the perspectives of both the clients and the professionals in the decision-making process, is shared decision-making (SDM). We explore how clients experience the SDM steps and to what extent they prefer it in their current and in their ideal interaction with professionals. Methods: We performed semi-structured interviews with fourteen clients receiving support in their RTW process from four different municipalities. Results: Clients emphasised the importance of being treated well, meaning: to be treated with respect, to be treated as equals, that professionals take a committed and personal approach, and trust their clients. None of the clients reported discussing a shared goal with a professional, or having been told that they could be part of the decision-making process. Most clients expressed that choice options have been presented either by professionals or by the clients themselves. When choice options were discussed, only the negative aspects of choice options were explained by the professional, such as legal restrictions or being told that the option was not suitable for the client according to the professional. A great number of clients experienced that shared decisions were made thanks to efforts made by both the client and the professional in equal measure. Other clients indicated that decisions were made for them. Conclusions: This study underlines the importance of how clients are treated and how this affects their RTW experience. Clients generally wish to cooperate and participate in the decision-making process, but their ability to do so is limited. Clients lack information, they do not know that they can participate in the decision-making process, and have different views on goals and choice options. This limits a client’s self-management in the RTW process.