Background
Methods
Focus Group Participants
Focus Group Procedure
Box 1: Topic Guide of the Focus Groups
Analysis
Results
Participants
Number | Country | Gender | Profession |
---|---|---|---|
1 | Belgium | F | Researcher of occupational and environmental medicine |
2 | Belgium | F | Employee of a reintegration bureau specialised in RTW of cancer survivors |
3 | Belgium | M | Government representative |
4 | Belgium | M | Researcher of RTW after cancer project |
5 | Belgium | M | Representative of fund for occupational diseases |
6 | Belgium | M | Employer of a healthcare organization |
7 | Belgium | F | Employer of a bank |
8 | Belgium | M | Trade Union representative |
1 | The Netherlands | M | Employer of a manufacturing company |
2 | The Netherlands | F | Employee of a reintegration bureau specialised in RTW of cancer survivors |
3 | The Netherlands | F | Employee of a reintegration bureau specialised in RTW of cancer survivors |
4 | The Netherlands | F | Government representative |
5 | The Netherlands | F | Workers’ representative |
6 | The Netherlands | M | Occupational health physician experienced in oncology |
7 | The Netherlands | F | Nurse specialized in RTW and cancer |
8 | The Netherlands | F | Representative of an OSH research institute |
1 | Ireland | M | National HR division, specialist registration in occupational medicine |
2 | Ireland | M | Trade union representative |
3 | Ireland | M | Trade union representative |
4 | Ireland | M | Representative of cancer support organisation |
5 | Ireland | M | Representative of cancer support organisation |
6 | Ireland | M | Occupational health nurse |
1 | UK | F | Researcher |
2 | UK | F | Vocational rehabilitation expert |
4 | UK | F | Employee of a cancer survivor society |
Barriers to and Facilitators of Implementing RTW Programs
Domain | Barriers to and facilitators of implementing RTW programs for cancer survivors | IE | UK | BE | NL |
---|---|---|---|---|---|
Overall societal context/culture and politics | Hard to implement knowledge (dissemination/implementation) | − | |||
Unclear who takes responsibility | − | − | |||
Avoiding conversation | − | ||||
Limited/sufficient knowledge about work and cancer by employer | −/+ | − | − | −/+ | |
Stigma | − | − | |||
Limited and wrong knowledge about legal right for employees | − | ||||
Culture makes it difficult/easy to disclose | −/+ | ||||
Individually approach | − | ||||
Correct knowledge about possible support for employees | + | ||||
Culture: view about work/rehabilitation | + | ||||
Cooperation between stakeholders | + | ||||
Workplace system | Level of information (too much/up to date) | + | |||
Avoiding conversation by employer | − | − | − | ||
Limited/sufficient knowledge and wrong/correct pre-assumptions about work and cancer by employer | − | − | −/+ | −/+ | |
Stigma | − | − | |||
Sufficient and correct knowledge about legal rights for employees | + | ||||
Organisation culture makes it easy to disclose | + | ||||
Individually approach | − | ||||
Limited/sufficient knowledge and wrong/correct knowledge about possible support for employees | − | + | + | ||
Time, money and ability are issues | − | − | − | + | |
No OHS in SME’s | − | − | − | ||
Organisation culture: view employer about rehabilitation/adjustments | −/+ | − | −/+ | −/+ | |
Role occupational physician | + | − | − | ||
Financial benefits/incentives | + | ||||
Structured approach | + | + | + | ||
Involvement stakeholders | + | + | |||
Training personnel | + | + | |||
Personal system/personal coping | Organisation culture makes it difficult to disclose | − | − | ||
Motivation, awareness and knowledge of cancer survivor | + | + | |||
Healthcare system | Unclear who takes responsibility | − | |||
Limited knowledge about work and cancer | − | − | − | ||
Limited/wrong knowledge about possible occupational support by healthcare providers | − | − | − | ||
Communication between stakeholders | − | − | |||
Legislative and insurance system | Level of information (too much/up to date) | − | |||
Financial benefits/incentives | − | + | −/+ | − | |
Legislation is missing | − | − |
Overall Societal Context/Culture and Politics
We also have people who get cancer, who immediately go on sick leave (….). While we know when you remain working, maybe in the beginning or later, it can even help you with the recovery, but they will not do that (..) so I think when we talk about providing information, it means also that employees will be provided with information about what they can do even if you get that diagnosis. [The Netherlands, #7]
But it is very difficult, THE cancer patient does not exist. There are so many different ones in addition to psychological ways of experiencing that episode [Belgium, #1]
And that’s where I think you see the fear. Neither side [employer/employee] wants to be the first one to initiate it [the conversation], because they’re afraid that they might do something wrong, or say something wrong [Ireland, M3].
Workplace System
Because I think the occupational physician is really a key figure with respect to return to work, staying at work, but that role has changed, so much. Stripped down.[The Netherlands, #5].
Yes, there’s comfort in knowing that it’s [policy] there, if or should you need it, but you have to know that it’s there, should you need it in the first place. And I think that’s the challenge. [Ireland, M1]
And what I see during dismissals is that they are really looking for cherry picking who they will keep and who not. That is also, I see a lot of people [who were diagnosed with cancer] of 50+ being made redundant. [The Netherlands, #7]
Personal System
I think it depends on the cancer. If you have a brain tumour, you might not want to tell your employer, especially depending on what you do. [UK, #2]
But I suppose that personal motivation would have a very powerful impact on them [the employer], to facilitate somebody coming back to work. [Ireland, F3]
Healthcare System
Sometimes you hear that cancer survivors say that they’ve been discouraged from going back to work by their clinicians. That happens very often, even if it might be in the patient’s interests. Clinicians will just look at cancer as a condition, and they don’t see any other aspect. [UK, #2].
It is essential that there is communication, a possibility of easy communication between the three involved physicians, to be honest. Between the treating physician, the insurance physician and the occupational physician. There is still no systematic solution for this.(Belgium, #4)
Legislative and Insurance System
I was in a very privileged position of working with companies who had paid for insurance [to provide sick pay for employees absent from work due to illness], so this was a service that we delivered under the umbrella of the employer’s own insurance. Their employees have a financial safety net. The way that we focussed it was, “Yes, you can ignore helping this person get back to work”. The ‘but’ was that, just as, if you’re in lots of car accidents, your premium next year will go up, there’s a financial piece underlying it for the employer if they can get a person productively back to work. [UK, #1]
..because the existing legislation looks like most of the time to be focusing on the protection of the employee but actually it is resulting in barriers regarding return to work, and in addition the legislation is not always in line with the needs of the employee or employer. [Belgium, #9]
if you’re not coming back on a full-time basis, you’re coming back on a part-time basis, you’re actually losing an element of money, but you can only get social welfare if you work a certain amount of hours per week.[Ireland, M3]