Bridging Health Care and the Workplace: Formulation of a Return-to-Work Intervention for Breast Cancer Patients Using an Intervention Mapping Approach.

Purpose An increasing number of breast cancer (BC) survivors of working age require return to work (RTW) support. Objective of this paper is to describe the development of a RTW intervention to be embedded in the care process bridging the gap between hospital and workplace. Method The Intervention Mapping (IM) approach was used and combined formative research results regarding RTW in BC patients with published insights on occupational therapy (OT) and RTW. Four development steps were taken, starting from needs assessment to the development of intervention components and materials. Results 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 impacts on (re-)employment; (2) exploration of 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; (5) step by step, the program as described in phase 4 will be executed. The occupational therapist monitors, measures and reviews goals and program-steps in the intervention to secure the tailor-made approach of each program-step of the intervention. Conclusion The use of IM resulted in a RTW oriented OT intervention. This unique intervention succeeds in matching individual BC patient needs, the input of stakeholders at the hospital and the workplace.

A conceptual-practice model for occupational therapy to facilitate return to work in breast cancer patients.

PURPOSE: Improved therapies and early detection have significantly increased the number of breast cancers survivors, leading to increasing needs regarding return to work (RTW). Occupational therapy (OT) interventions provide successful RTW assistance for other conditions, but are not validated in breast cancer. This paper aims to identify a theoretical framework for OT intervention by questioning how OT models can be used in OT interventions in RTW of breast cancer patients; criteria to be used to select these models and adaptations that would be necessary to match the OT model(s) to breast cancer patients' needs? METHODS: Using research specific criteria derived from OT literature (conceptual OT-model, multidisciplinary, referring to the International Classification of functioning (ICF), RTW in breast cancer) a search in 9 electronic databases was conducted to select articles that describe conceptual OT models. A content analysis of those models complying to at least two of the selection criteria was realised. Checking for breast cancer specific issues, results were matched with literature of care-models regarding RTW in breast cancer. RESULTS: From the nine models initially identified, three [Canadian Model of Occupational Performance, Model of Human Occupation (MOHO), Person-Environment-Occupation-Performance model] were selected based on the selection criteria. The MOHO had the highest compliance rate with the criteria. To enhance usability in breast cancer, some adaptations are needed. CONCLUSION: No OT model to facilitate RTW in breast cancer could be identified, indicating a need to fill this gap. Individual and societal needs of breast cancer patients can be answered by using a MOHO-based OT model, extended with indications for better treatment, work-outcomes and longitudinal process factors.

Occupational therapy and return to work: a systematic literature review.

BACKGROUND: The primary aim of this review study was to gather evidence on the effectiveness in terms of return to work (RTW) of occupational therapy interventions (OTIs) in rehabilitation patients with non-congenital disorders. A secondary aim was to be able to select the most efficient OTI. METHODS: A systematic literature review of peer-reviewed papers was conducted using electronic databases (Cinahl, Cochrane Library, Ebsco, Medline (Pubmed), and PsycInfo). The search focussed on randomised controlled trials and cohort studies published in English from 1980 until September 2010. Scientific validity of the studies was assessed. RESULTS: Starting from 1532 papers with pertinent titles, six studies met the quality criteria. Results show systematic reviewing of OTIs on RTW was challenging due to varying populations, different outcome measures, and poor descriptions of methodology. There is evidence that OTIs as part of rehabilitation programs, increase RTW rates, although the methodological evidence of most studies is weak. CONCLUSIONS: Analysis of the selected papers indicated that OTIs positively influence RTW; two studies described precisely what the content of their OTI was. In order to identify the added value of OTIs on RTW, studies with well-defined OT intervention protocols are necessary.