Tailoring work participation support for cancer survivors using the stages of change: perspectives of (health care) professionals and survivors

Abstract

Purpose Interventions to support work participation in cancer survivors (CSs) have shown limited effectiveness. Applying a behavioral change framework (e.g., stages of change) could make work participation interventions for CSs more timely and tailored. We aimed to explore the application of the stages of change framework to work participation support for CSs and to generate stage-specific intervention content. Methods Eighteen experts (e.g., occupational physicians, reintegration consultants) were individually interviewed, and three focus groups with CSs (n = 6, n = 5, n = 4) were conducted. Data were analyzed along the six work-related behavioral change stages purported by the readiness for return to work framework, which is based on the stages of change. Results The following themes were identified: (1) pre-contemplation: emotional support and staying connected—encourage contact with the employer/colleagues; (2) contemplation: considering return to work is stressful—facilitate the deliberation process; (3) preparation self-evaluative: assess current capabilities—seek guidance from, e.g., occupational physicians; (4) preparation behavioral: planning return to work—allow for personalized solutions and encourage supervised return to work; (5) uncertain maintenance: guard against overload—train self-efficacy strategies and communication tactics; and (6) proactive maintenance: accept and prepare for the long term. Conclusions Our results support the potential utility of tailoring CSs’ work participation support along the stages of change. Implications for Cancer Survivors We provided recommendations for intervention content and developed a stage-specific work participation intervention for CSs, the effectiveness of which will be evaluated in an upcoming randomized controlled trial.

Work resumption and retention in patients with advanced cancer: Experiences and perspectives of general and occupational health care professionals

“…Both interns were supervised by authors ADZ, LB, and SFAD (a PhD candidate, postdoctoral researcher, and senior researcher, respectively, all with a research focus on psychosocial oncology and/or palliative care). ADZ, LB, and SFAD have experience in conducting qualitative research (e.g., Zegers et al, 2022 ).…”

“…Moreover, the ability to work can offer cancer patients a sense of identity and purpose (Chow et al, 2015 ; Faas, 2018 ; Greidanus et al, 2018 ). However, many cancer patients experience barriers when resuming work during or after treatment, for example, fatigue (Nielsen et al, 2019 ; Paltrinieri et al, 2018 ; Zegers et al, 2022 ). For those with advanced cancer, additional barriers may arise due to disease progression, symptom burden, and/or ongoing (palliative) treatments (Glare et al, 2014 ).…”

“…Vocational rehabilitation of cancer patients is influenced by myriads of factors, for example: personal, medical, socio‐legal, and employer‐related factors (Greidanus et al, 2018 ; Paltrinieri et al, 2018 ; Van Muijen et al, 2013 ). Thus, not only cancer patients encounter barriers during work resumption and work retention; general and occupational health care professionals can experience difficulties guiding patients throughout this process as well (Greidanus et al, 2018 ; Morrison et al, 2015 ; Tiedtke et al, 2014 ; Yagil et al, 2019 ; Zegers et al, 2022 ). Findings of Glare et al ( 2017 ) showed that work remains an important topic for many patients with advanced cancer, and involved professionals therefore need to be competent in discussing work‐related issues with them and providing tailored supportive care (Glare et al, 2017 ).…”

Cancer survivors and adverse work outcomes: associated factors and supportive interventions

“… 64 When developing such an intervention, lessons can be learned from other cancer survivorship interventions that are personalized, such as OncoKompas. 65 Another example of how an intervention can be tailored to the needs of specific cancer survivors is the STEPS intervention, 66 in which a behavioural change framework is used to adapt a work participation intervention to the ‘stage of change’ a particular cancer survivor is in.…”

Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective

“…Duijts et al identified the Transtheoretical Model of Behavior Change (TTM) as a relevant theoretical framework for developing these interventions [14,15]. A recent qualitative study endorses the value of tailoring support for the work participation of cancer survivors along the stages of change described by the TTM [16]. However, the TTM alone cannot account for all the complexities of behavior change, particularly when studying the multidimensional process of RTW [13,14].…”