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PXL-Healthcare 2017 --- ergotherapeutische vaardigheden --- borstkanker --- arbeidsintegratie --- doctoraatsthesis

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Of the more than 10.000 newly diagnosed breast cancer (BC) patients in Belgium, the mean age of 62 is decreasing every year due to an increase in BC incidence in younger people. At the moment, almost 30% of BC diagnoses in Belgian women occur before the age of 65. With 5-year survivals that stretch beyond 80%, and survival rates evolving in a positive trend, many BC patients are confronted with questions regarding (return to) work (RTW). The burden of disease and treatment affects personal, social and financial aspects as well as health aspects of patients’ lives. Thereby, it affects patients’ quality of life (QoL), functionality and participation in society. As treatment focuses mainly on the cancer itself, BC patients report unmet needs regarding psychosocial issues during treatment and beyond. For working-age BC patients, being able to work (again) does not only mean a return to ‘normalcy’, it also contributes to the restoration of other important aspects of their lives (e.g. providing an income for themselves and their loved ones, having social contacts, personal growth, etc.). Being able to return to work is far from self-evident for any cancer patient and appears even more problematic for women. International research as well as Belgian research has shown that almost 40% of working-age BC patients do not return to work successfully. This explains the needs that are expressed by BC patients regarding support that could help them to maintain or regain work.To date, not only the needs of patients regarding support in RTW remain unmet, but in addition programmes that support RTW in BC patients are not yet available in a structural way. In the Belgian legal and social context, an evolution is currently ongoing, with a shift from an income-compensation model to a participation-support model. This evolution is encouraging towards RTW support for many patients with chronic health issues. However, it challenges health care and social systems to provide services that are tailored to patients’ needs. Furthermore, not only BC patients but also other stakeholders (e.g. employer, co-worker, and social security) are faced with unsolved questions when RTW of BC patients is at stake. In this study, RTW is considered as the target of a process, mutually agreed upon by stakeholders who participate in the RTW process of an individual BC patient.Research clearly indicates that RTW support has to be health care based and be provided as early as possible during survivorship of BC patients. Therefore, the RTW intervention we aim to develop in this PhD study will be hospital based and available for BC patients from the moment of diagnosis. In order to integrate RTW support with the current care by multidisciplinary teams (MDT), it is necessary that team members can use competencies needed to do so.We started our research by investigating the effectiveness of OT interventions on RTW in diverse patient groups (study 1). Studies on OT interventions for RTW in BC patients could not be found. Our search of peer-reviewed papers using electronic databases (Cinahl, Cochrane Library, Ebsco, Medline (Pubmed), and PsycInfo) focussed on randomised controlled trials and cohort studies published in English from 1980 until September 2010. Of 1,532 papers initially selected with pertinent titles, we retained six studies that met our quality criteria, of which only two described precisely the content of the OT intervention. Systematically reviewing (the effectivity of) OT interventions on RTW was challenging due to varying populations, different outcome measures, and poor descriptions of methodology. Our results showed moderate evidence for OT interventions - when part of rehabilitation programs – increasing RTW rates.Study 2 was set up to enable us to explore experts’ opinions on OT interventions for RTW in BC patients in the Belgian context, by: i) topic-interviews with all heads of OT departments in Flemish University Hospitals (n=5) and ii) four focus group interviews with care professionals in oncological rehabilitation, some of which were BC survivors at the same time (n=41). The experts agree RTW interventions should be integrated in multidisciplinary teamwork, have a holistic and client-centred approach, start early in the rehabilitation process, include workplace visits as well as contacts with relevant stakeholders, and use goal-setting to start up tailor-made rehabilitation that links assessment of abilities to work requirements. According to the experts, OT guided RTW interventions might be useful for BC patients when integrated in regular health care and compliant with the above-mentioned components. The experts refer to occupational therapists as professionals who effectively can answer BC patients’ unmet needs regarding RTW due to OT competences and skills in bridging between health care and workplace. The experts agree on organisational and financial barriers that should be removed at a Belgian legal and a societal level (e.g. not reimbursing for inclusion of this type of support through health care insurance). The results of study 2 also clarify the lack of a theoretical foundation to base an OT guided RTW intervention for BC patients on.Study 3 aimed to identify a theoretical framework for an OT intervention in BC. We determined criteria (e.g. conceptual OT model multidisciplinary, ICF referred, RTW in BC) to be used to select these models. Referring to the lack of BC specific information we found in study 1, we also considered potential adaptations that would be necessary to match the OT model to BC patients’ needs. Using research specific criteria derived from OT literature, a search in nine electronic databases was conducted to select articles that describe conceptual practice OT models. No OT model for RTW in BC could be identified, indicating a need to fill this gap. A content analysis of those models complying with - at least - two of the selection criteria was realised. This resulted in the selection of three models: Canadian Model of Occupational Performance (CMOP), Model of Human Occupation (MOHO), Person Environment Occupation Performance model (PEOP). The MOHO had the highest compliance rate with the criteria. However, in order to enhance usability in BC, some adaptations are needed (e.g. indications for better treatment, work-outcomes and longitudinal process factors). We added to this model insights from models that support RTW in BC patients but were not specific for OT. Study 3 resulted in an ‘organizing model of OT practice for RTW in BC’ that is to be used as a basis for the RTW intervention this PhD study aims for.In order to guide the development process in this PhD study, Intervention Mapping (IM) was used in study 4, in combination with the results of studies 1, 2, and 3. Advocating a systematic use of research literature, the IM approach presents a logical, methodical, step-by-step procedure that helps to organize researchers’ thinking as they move on from theory and evidence to practice. Study 4 presents four of the six IM development steps in total. Steps 5 and 6 are part of the evaluation, they will be organised in further research. A five-phased RTW intervention guided by a hospital-based occupational therapist is proposed: 1) assessing the worker, the usual work and contextual factors which impact on (re-)employment; 2) exploring the match / differences between the worker and the usual work; 3) Establishing long term goals, broken down into short term goals; 4) setting up tailored actions by carefully implementing results of preceding phases; and 5) executing the program as described in phase 4.This PhD study presents some clear results: i) to support BC patients in solving problems regarding RTW, competencies of occupational therapists are useful to facilitate maintaining or regaining patients’ labour-participation; ii) results of international literature and of the Belgian situation regarding RTW for BC patients present fragmented information, with differences in (roles of) stakeholders and contexts; iii) developing a more “generic” model that relies on the existing frames of references and available evidence makes it possible to fill in the existing shortages in current health care, and iv) using IM enables determination of elements essential for a RTW intervention for Belgian BC patients.Further research will have to focus on feasibility and process evaluation of the intervention that will be described in detail. With the funding of KOTK , this research will be performed and might lead to a well-defined and implementable RTW intervention for which a multicentre randomised controlled trail effectivity research could be set up. The ‘generic’ model we developed might be elaborated and tested for its ‘generic’ and ‘practicable’ quality in cross-country comparisons.

Academic collection --- Theses

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Van de hipste kantoren met verstelbare werkplekken tot innovatieve hulpmiddelen in de zorgsector om patiënten veilig te verplaatsen, ergonomie is overal. En maar goed ook, want door ergonomische principes toe te passen, kunnen we werknemers helpen om hun taken en hun omgeving op elkaar af te stemmen. Daardoor kunnen ze hun werk vlotter, veiliger en duurzamer uitvoeren zonder hun gezondheid in het gedrang te brengen. In De mens in zijn omgeving maak je kennis met de ergonomische principes op de werkvloer. Die zullen je helpen begrijpen waarom bepaalde activiteiten op sommige plekken moeilijk of vermoeiend zijn, en vooral hoe je daar verandering in kunt brengen. Je leert kritisch naar werkplekken kijken en draagt zo bij aan duurzamere loopbanen. Met talloze voorbeelden en praktische toepassingen helpen de auteurs je om de theorie in de praktijk om te zetten. https://borgerhoff-lamberigts.be/boeken/de-mens-in-zijn-omgeving

Ergonomie --- Arbeidsomstandigheden --- Risicoanalyse --- Arbeidstevredenheid --- Arbeids- en organisatiepsychologie --- Arbeidsmotivatie --- Werkruimten --- arbeidstevredenheid --- Arbeidspsychologie --- Organisatiepsychologie --- arbeidsmotivatie --- 331.4 --- Industrial psychology --- Personnel management --- ergonomie --- organisatiepsychologie --- Werkplaatsen --- Human engineering --- Preventie en bescherming op het werk --- heelkunde --- ergotherapie

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