Implementing Indicators and Trajectories of Return to Work After Breast Cancer Diagnosis: A Mixed-Methods Study Using the French National Healthcare Insurance Database and Stakeholder Consultation.

PURPOSE: Return to work (RTW) is important for quality of life after breast cancer but its analysis at the population-level remains limited in France. This study aimed to implement Electronic Healthcare Data (EHD)-based indicators and trajectories to measure RTW after breast cancer diagnosis, and to examine stakeholders' perspectives regarding these indicators. METHODS: We followed a mixed-methods approach that consisted of (i) implementing RTW indicators and identifying clusters of trajectories using state sequence analysis with data from a representative sample of the French National Health Data System and (ii) exploring, through qualitative focus group and interviews, stakeholders' perceptions on the interpretation, limitations, and utility of these indicators. RESULTS: We extracted data from 317 women aged 25-55 years with a first diagnosis of early-stage breast cancer. The median number of sickness absence periods was 2 for a total of 434 days during the 3-year follow-up, and the median time to sustainable RTW was 240 days. Three clusters of RTW trajectories were identified: "early RTW" (49.5% of the population), "RTW after partial resumption" (37.5%) and "continuous compensation" (12.9%). Feedback from stakeholders highlighted the multi-factorial nature of RTW and underscored the added value of EHD for studying RTW, despite certain limitations. CONCLUSIONS: We demonstrated the feasibility of calculating RTW indicators and identifying trajectories using the French National Health Data System. These indicators can serve as outcome measures in RTW promotion and provide a basis for designing targeted interventions for breast cancer survivors.

Are vaccination uptake and non-uptake influenced by our emotions? An experimental study on the role of emotional processes and compassion.

OBJECTIVE: This study examined the effects of emotional arousal, emotional competence, emotion regulation (ER), and compassion on COVID-19 and flu vaccination intentions (VI) among the French population. DESIGN: Data were collected online from October to December 2020. Altogether, 451 participants (Mage = 35.8, SD = 16.4) were allocated to four groups. High positive (n = 104) or negative (n = 103) emotional arousal were induced into two groups using pictures and music, and compared against a control group (flu group; n = 116) and a reference group (COVID-19 group; n = 114). All groups completed questionnaires on emotional arousal, ER, emotional competence, compassion, and VI. RESULTS: The findings indicated a significant effect of group on VI, h2=.023, 95% CI [-.002, .09]. The Group*Gender interaction on emotional arousal was non-significant, ηp2=.015, 95%CI [.000, .041]. However, emotional arousal was observed to have a significant main effect on VI, ηp2=.09, 95% CI [.043, .238]. The ER type*Emotional arousal*Gender interaction on ER use was trend, ηp2 = .002, 95% CI [.000, .005]. The emotional competence*ER type interaction on ER use was significant, ηp2 = .028, 95% CI [.011, .049]. Only experiential avoidance mediated the relationship between emotional arousal and VI, p < .018, 95% CI [.015, .18]. CONCLUSION: Emotional arousal impacts VI. High emotional competence only reduces the use of dysfunctional ER strategies.

Hesitancy towards COVID-19 Vaccination among Healthcare Workers: A Multi-Centric Survey in France.

Vaccination programs against COVID-19 are being scaled up. We aimed to assess the effects of vaccine characteristics on vaccine hesitancy among healthcare workers in a multi-center survey conducted within French healthcare facilities from 1 December 2020 to 26 March 2021. We invited any healthcare workers naïve of COVID-19 vaccination to complete an online self-questionnaire. They reported on their socio-demographic characteristics, as well as their perception and beliefs towards vaccination. We measured their willingness to get vaccinated in eight scenarios for candidates' vaccines presented sequentially (1 to 4-point scale). Candidates' vaccines varied for efficacy (25%, 50%, 100%), length of immunization (1 year or lifetime), frequency (<1/100, <1/10,000), and severity (none, moderate, severe) of adverse events. We analyzed 4349 healthcare workers' responses with interpretable questionnaires. The crude willingness to get vaccinated was 53.2% and increased over time. We clustered the trajectories of responses using an unsupervised classification algorithm (k-means) and identified four groups of healthcare workers: those willing to get vaccinated in any scenario (18%), those not willing to get vaccinated at all (22%), and those hesitating but more likely to accept (32%) or reject (28%) the vaccination depending on the scenario. In these last two subgroups, vaccine acceptance was growing with age, educational background and was higher among men with condition. Compared to an ideal vaccine candidate, a 50% reduced efficacy resulted in an average drop in acceptance by 0.8 (SD ± 0.8, -23.5%), while it was ranging from 1.4 (SD ± 1.0, -38.4%) to 2.1 (SD ± 1.0, -58.4%) in case of severe but rare adverse event. The acceptance of a mandatory immunization program was 29.6% overall and was positively correlated to the willingness to get vaccinated, ranging from 2.4% to 60.0%. Even if healthcare workers represent a heterogeneous population, most (80%) could accept the vaccination against COVID-19. Their willingness to get the vaccine increased over time and as immunization programs became available. Among hesitant professionals, the fear of adverse events was the main concern. Targeted information campaigns reassuring about adverse events may increase vaccine coverage, in a population with a strong opinion about mandatory immunization programs.

Seasonal flu vaccination, a matter of emotion? An experimental study on role of compassion, socioeconomic status and perceived threat among healthcare workers.

OBJECTIVE: This study tests the impact of threat on compassion and vaccination intention among healthcare workers (HCWs) with low and high socio-economic status (SES) in France. DESIGN: A total of 309 HCWs were analyzed (Mage=39.29, SD = 11.76). Participants with high (n = 138) or low (n = 171) SES were randomly assigned to a Threat (n = 187) versus a No-Threat (n = 122) condition through filling in MacArthur's scale. During this manipulation, participants read about an interaction involving a HCW with an SES higher than that of the participant. After filling in the MacArthur scale, all participants went through a compassion manipulation. Finally, participants read a text describing a patient's distress. MAIN OUTCOME MEASURES: The primary outcome was the vaccination intention score. The secondary outcome included the compassion score. RESULTS: The interaction of the Group X SES Subjective on compassion was not significant (p = .34, ηp2 = .003, 95%CI [-.39,.07]). The interaction of the Group X Diploma on vaccination intention with high compassion was significant (p<.001, ηp2 = .173, 95%CI [.11,1.68]). Planned comparisons revealed a significant difference in vaccination intention score between HCWs with low SES between Threat (M = 3.58, SD = 2.56) and No-Threat (M = 5.27, SD = 2.27; p=.01) conditions. CONCLUSION: Ultimately, compassion inhibited the distress elicited in the threat condition in HCWs with high compassion.