Quasi-experimental

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Observational

Peer Reviewed:

Yes

Implementation of supported employment for homeless veterans with psychiatric or addiction disorders: Two-Year outcomes

Authors:

Rosenthal, D. A., Dalton, J. A. & Gervey, R.

Year Published:

2007

Publication:

Psychiatric Services

Volume:

Number:

Pages:

325-333

Publisher:

American Psychiatric Association

Background:

Experimental studies have robustly demonstrated the effectiveness of the Individualized Placement and Support (IPS) model of supported employment services for people with severe mental illness, and several studies of real-world implementation have shown significant cross-sectional correlations between employment success and fidelity to the IPS model. Experiences with IPS programs have stimulated broad efforts to disseminate evidence-based practices. Although multiple dissemination efforts are underway, analyses on the benefits of efforts to disseminate IPS have been on cross-sectional and site-level data, rather than on longitudinal information on individual clients. To implement IPS in health care systems with limited previous experience, sustained and individualized training programs may be needed to realize potential client benefits. Few studies have demonstrated that IPS, or other evidence-based practices for that matter, can both be implemented in a system that lacks prior experience with the model and yield outcomes for comparable cohorts that are superior, over several years, to those of a comparison group for which this intervention was not available.

Purpose:

This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1).

Setting:

The setting included 9 Veterans Administration Programs for Homeless Veterans.

Sample:

A total of 308 veterans were recruited during phase 1, starting in January 2001, when IPS was still unavailable anywhere in the VA. An additional 321 veterans were recruited in phase 2, starting in July 2001, after the IPS employment specialist had been hired and trained, and were invited to participate in IPS for at least two years. Follow-up data collection continued through March 2005.

Data Collection:

Participants in phase 1 were compared with participants in phase 2 on baseline characteristics by using chi square tests and t tests. All available participants were included in all analyses whether or not they were currently participating in IPS. Mixed models were then used to compare outcomes between the phases over the two-year follow-up period, controlling for baseline differences, using the MIXED procedure of SAS, with the alpha set at <.05.

Intervention:

Training began with a one-day, on-site, face-to-face orientation for both employment specialists and other VA mental health staff that was led by a social worker with experience training IPS specialists and conducting IPS fidelity ratings. For the duration of the project regular teleconferences continued providing weekly individual case reviews for the first three months, monthly individual case review conferences, and monthly conference calls with all nine employment specialists jointly. A review of ratings of model fidelity at six, 12, and 18 months after program implementation was also performed with a modified version of the IPS fidelity scale. Training was provided by a social worker with extensive experience disseminating the IPS model in other research projects. He was assisted by a VA occupational therapist with experience in supported employment. Monthly conference calls were also held with administrators responsible for program implementation at each site.

Control:

Phase 1 control group did not receive IPS services. Comparison was made with Phase 2 group who did receive IPS services.

Findings:

Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures. (Psychiatric Services 58:325‚Äî333, 2007)

Conclusions:

A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.

URL:

http://www.nchv.org/images/uploads/Implementation_of_Supported_Employment_for_Homeless_Veterans_With_Psychiatric_or_Addiction_Disorders-Two-Year_Outcomes.pdf

Disabilities:

Populations:

Asian

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

What are the benefits of evidence-based supported employment for patients with first-episode psychosis?

Authors:

Rose J., Saunders K., Hensel, E., & Kroese, B. S.

Year Published:

2004

Publication:

Psychiatric Bulletin

Volume:

Number:

Pages:

281-284

Publisher:

Royal College of Psychiatrists

Background:

Early intervention services provide community-based treatment and support to young people with psychosis and their families, with an emphasis on maintaining normal social roles. The experience of psychosis can exclude a young person from a sense of autonomy, employment and youth culture. Young people aspire to social roles and goals: employment and education provide social identity and status, social contacts and support, a means of structuring and occupying time, activity and involvement, and a sense of personal. Quite apart from the money that can be earned, work tells us who we are and enables us to tell others who we are.

Purpose:

The purpose of the study was to examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Setting:

The Early Treatment and Home-based Outreach Service (ETHOS) is an early intervention service that has been in operation within South West London and St George‚ Mental Health National Health Service (NHS) Trust since June 2001. It provides a comprehensive package of community-based care for a maximum of 2 years to young people (aged 17-30 years) with a first episode of psychosis.

Sample:

The vocational specialist worked with all 40 patients within the service; 35 had a diagnosis of schizophrenia and 5 had diagnoses of other psychoses. The median age was 21 years with a range of 18-32 years.

Data Collection:

Data were collected from November 2001 to November 2002 for all patients who received vocational input. This information included:
‚Ä¢ demographic variables: age, gender, ethnicity;
‚Ä¢ clinical variables: primary diagnosis, duration of contact with the team, discipline of care coordinator.
Information on vocational status was collected on first contact with each patient and thereafter on a monthly basis.

Intervention:

A half-time vocational specialist was integrated into the ETHOS team to address the vocational needs of patients within the service. This specialist (K.M.) was an integral member of the multidisciplinary team but did not carry out care coordinator tasks. She coordinated all the vocational plans with the team, and worked directly with patients and their care coordinators to ensure that vocational goals were given a high priority. Direct client interventions included engagement, assessing vocational need, proactively helping patients to find (and keep) jobs and attend education courses, providing welfare benefits advice, addressing support needs and ensuring adjustments to enable patients to keep their jobs or remain in education. All patients within the service (n=40) received an intervention for 6 months, and 22 clients received it for 12 months.

Control:

There was no control or comparison condition.

Findings:

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying good implementation

Conclusions:

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service. These results lend support for an evidence-based supported employment approach where vocational rehabilitation is integrated into the clinical team, to help people with severe mental health problems gain and retain employment and education. There is a national commitment to the development of early intervention services, and consideration needs to be given to the successful engagement and outcomes of young people with first-episode psychosis within services. If these young people aspire to social roles and goals, then helping them to gain and retain employment and education should not only improve longer-term outcomes but also provide a potential key to engagement.

URL:

http://pb.rcpsych.org/content/28/8/281

Disabilities:

Populations:

White / Caucasian

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Mixed methods

Peer Reviewed:

Yes

Impact of public support payments, intensive psychiatric community care, and program fidelity on employment outcomes for people with severe mental illness

Authors:

Rinaldi, M., Mcneil, K., Firn, M., Koletsi, M., Perkins, R., & Singh, S. P.

Year Published:

2003

Publication:

The Journal of Nervous and Mental Disease

Volume:

191

Number:

Pages:

139-144

Publisher:

Lippincott, Williams and Wilkens

Background:

Supported employment is an evidenced based practice that assists individuals with mental illness with gaining and maintaining employment. One of the major barriers to work are disability payments offered by the Social Security Administration and the Veterans Administration. A few studies have shown that the amount of public income is negatively associated with employment, involvement with vocational rehabilitation services and income received from employment. There are no studies related to to the impact of disability benefits on employment of those individuals who receive intensive case management services.

Purpose:

The purpose of this study was to explore the relationship between income from public support, participation in Intensive Psychiatric Community Care and employment among veterans with severe mental illness.

Sample:

The sample included 520 veterans with severe mental illness who were randomly assigned to either IPCC or standard care. Prior to entering the study the majority or 87.5% were receiving at least one form of public payment. The average amount was nine hundred and fifty five dollars.
At the 12 month follow up interview, most of the sample 91.2%) were classified as non workers. There were few differences on baseline and demographic and mental health status. There was a significant difference between workers and non-workers on the amount of public income received in the month prior to baseline assessment, with non workers receiving more money.

Data Collection:

Demographic and mental health status were obtained through participant interviews at baseline and one year out. Symptom severity was measured using the Brief Psychiatric Rating Scale. Alcohol and drug use were examined using scores from the Addiction Severity Index. Functional status was assessed using the Global Assessment Scale. Fidelity to the IPCC Model was measured using the Dartmouth Assertive Community Treatment scale. A liberal measure was used to determine employment. In the data analysis, only composite scores were examined. Bivariate analyses were used to examine differences between demographic and mental health status variables. Multivariate logistic regression was used to look at the contribution of the independent variable.

Intervention:

The intervention was Intensive Psychiatric Community Care (IPCC).

Control:

The control condition was standard care.

Findings:

Public support levels were inversely related to employment. Symptom severity did not appear to be an independent barrier to work.

Conclusions:

Previous analyses of this study did not look at infrequent outcomes like employment. However, there is value in doing so as the results revealed the impact of assertive case management on employment outcomes.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/12637839

Disabilities:

Populations:

White / Caucasian

Veterans

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

"Cancer survivorship and work: Symptoms, supervisor response, co-worker disclosure and work adjustment"

Authors:

Rabren, K., Dunn, C., & Chambers, D.

Year Published:

2007

Publication:

Journal of Occupational Rehabilitation

Volume:

Number:

Pages:

83-92

Publisher:

Springer

Background:

Advances in medicine have increased people's survivorship from cancer and their ability to work both during and after treatment. However, the impact that diagnosis and treatment has on psychosocial factors that may impact an individual's ability to work is not fully understood.

Purpose:

This purpose of this study was to explore the impact of symptoms, work adjustments, and disclosure of one's disability to supervisors and co-workers on employment both during and after treatment.

Setting:

The study was conducted in the United Kingdom via mailed questionnaire.

Sample:

The participants were 328 cancer survivors. Forty five types of cancer were represented and categorized into the eight areas representing the cancers' site. This included: breast, colorectal, genital, head and neck, lymph, prostate, melanoma and other. Treatments included: oral medication, surgery, chemotherapy and radiotherapy. The majority of the participants were female (77%). The age range was between 18 to 68 years. Participants worked in a range of occupations with the majority or 54% working in skilled/operational-non manual.

Data Collection:

A 33 item questionnaire was used to gather information about demographics, information about cancer, symptoms associated with cancer and its treatment, disclosure of cancer at work, and work supports. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment

Intervention:

Interventions included disclosure of disability and various types of work accommodations, particularly flexible scheduling and paid leave for all medical appointments.

Control:

There was no control or comparison condition.

Findings:

Thirty percent of the sample continued to work during treatment. There were no significant differences between cancer groups, type of treatment received or age groups. Flexibility with work arrangements, and disclosure were factors related to working during treatment. Working during treatment was also associated with difficulties managing fatigue. Forty two percent of the respondents returned to work following treatment. Factors related to return to work following treatment included: difficulties managing fatigue, managing the stress of cancer, managing physical changes associated with cancer, receiving advice from their doctor about work and return to work meeting with their employer.

Conclusions:

The study adds to the scant literature on experiences of cancer survivors. Further research is needed to better understand ways to assist survivors with return to work.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/17318459

Populations:

Outcomes:

Return to work

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Using telehealth interventions to prevent pressure ulcers in newly injured spinal cord injury patients post-discharge. Results from a pilot study

Authors:

Porteous, N., & Waghorn, G

Year Published:

1999

Publication:

International Journal of Technology Assessment in Healthcare

Volume:

Number:

Pages:

749-755

Publisher:

Cambridge Journals

Background:

Spinal cord injuries (SCIs) are rare but catastrophic occurrences. They produce permanent changes in sensory and motor function and physical impairments that restrict mobility, often completely. Although definitive statistics are lacking, studies estimate the incidence of spinal cord injuries to range from 30 to 50 cases per million people. Because of the profound physiological impact of SCIs, those affected are at increased risk for secondary health problems. Pressure sores or ulcers have been identified as one of the most common problems.

Purpose:

The purpose of this study was to determine which of three approaches to care produces the lowest incidence of pressure ulcers, promotes the most effective care of sores that develop, and leads to the fewest hospitalizations in newly injured patients with spinal cord injury after discharge.

Sample:

The sample included 37 individuals with newly acquired spinal cord injury.

Data Collection:

All three groups were surveyed every 2‚Äì3 months about doctor, hospital, and emergency room visits, calls to the Shepherd Center helpline, ulcer occurrences and characteristics, and employment status. Data on participant characteristics were analyzed using the Kruskal-Wallis rank sum test and k-sample chi-square tests for continuous and categorical variables. Outcome data were analyzed using Friedman‚ test to investigate response differences for multiple treatments applied to a series of subjects.

Intervention:

The intervention was Telehealth care services. This included video intervention and telephone support.

Control:

The comparison condition was standard care.

Findings:

The video group had the greatest number of reported and identified pressure ulcers. Differences in health care utilization between the video and telephone telehealth groups were small. The standard care group reported the lowest number of pressure ulcers and lowest frequency of health care utilization. Substantial differences existed in employment rates before and after injury. The video group had the lowest pre-injury rate of employment and the highest post-injury rate of employment.

Conclusions:

Tracking pressure ulcer incidence, particularly stage I sores, is difficult. Self-report is likely to lead to substantial underreporting. Similarly, self-report on health care utilization over extended periods may lead to undercounting of encounters. Telehealth interventions appear to improve ulcer tracking and management of all ulcer occurrences. Video interventions may affect outcomes, such as employment rates, which are not conventionally measured.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/10645116

Populations:

Male

Outcomes:

Other

NIDILRR Funded:

Research Design:

Traumatic brain injury (TBI)

Peer Reviewed:

Yes

The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury

Authors:

Ottomanelli, L., & Lind, L.

Year Published:

2004

Publication:

Archives of Physical Medicine and Rehabilitation

Volume:

Number:

Pages:

68-72

Publisher:

Elsevier

Background:

Employment is compromised for individuals with traumatic brain injury (TBI). Rates after TBI range from 10% to 70% .The literature reports on successful work outcomes for some with the use of specialized or intensive rehabilitation intervention. In spite of a number of intensive demonstration projects focusing on vocational rehabilitation (VR) and some research showing the effectiveness of certain program components, many persons with TBI remain unserved or underserved within the VR system. Individuals with TBI access VR services at rates that are much lower than other consumers relative to their prevalence in the general population. In addition to being underrepresented in counselor caseloads, people with TBI are less successful than other consumers in obtaining and maintaining competitive employment.

Purpose:

The purpose of the paper was to describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to individuals with traumatic brain injury (TBI). The PWW includes many of the best practices suggested by previous research such as: functional cognitive remediation, job coaching, psychosocial counseling, job development and placement services, and fostering a strong relationship with the counselor via person-centered planning.

Setting:

The setting included communities and two district vocational rehabilitation offices in the state of New York.

Sample:

The study sample was made up of 42 individuals who had been accepted by New York State's VR program for services. The majority or (34)were men. Half of the group (21) received traditional services and the other half participated in the PWW. In terms of ethnicity, the majority of participants were nonwhite (i.e.. black and Asian). Related to education, close to half (48%) had not completed high school.

Data Collection:

The following data were gathered from VESID central files for fiscal years 2001 (October 1, 2000‚ÄìSeptember 30, 2001) and 2002 (October 1, 2001‚ÄìSeptember 30, 2002): case status (26 successfully placed for 90 days, 28 closed after IPE-initiated, 30 closed before IPE initiated, 8 closed before IPE developed), weekly earnings at closure, hours worked per week at closure, cost of case services provided to each consumer, consumer demographic characteristics (gender, level of education, employment status at application, ethnicity, age), and name of the state VR counselor serving the consumer. By using case status, the proportion of successful closures (i.e., case status 26) were compared with unsuccessful closures (i.e., case status 8, 28, and 30) for the PWW counselors and other counselors in the catchment areas served by using Pearson chi-square analyses. One-tailed t tests were used to compare weekly earnings at closure, hours worked per week at closure, and cost of services for PWW consumers versus the matched consumers.

Intervention:

All participants went through the initial VR procedures for eligibility determination and development of an individualized employment plan. Individuals in the receiving traditional services were referred to various outside organizations for services and followed by the vocational rehabilitation counselor. Individuals in the PWW group received person centered, community based services from consultants who were recruited, trained and supervised by a VR counselor.

Control:

Each PWW participant was matched to a VR client receiving traditional services on gender, age, ethnicity, and education at referral.

Findings:

Fifty-seven percent of the PWW consumers were successfully closed compared to only 24% of the matched consumers who received traditional services. The proportion of successful closures for PWW versus unsuccessful closures was significantly greater for this group. PWW participants earned 204 dollars more a week and worked an average of 14 hours more than the other group. The cost of services for the PWW participants was 260 dollars more than the group who received traditional services.

Conclusions:

The PWW approach seems promising. More research is needed to determine its utility in assisting individuals with TBI with employment.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/15083424

Disabilities:

Populations:

Asian

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Improving the vocational status of patients with long-term mental illness: a randomized controlled trial of staff training

Authors:

O'Neill, J. H. , Zuger, R. R., Fields, A.,Fraser, R., & Pruce, T.

Year Published:

2003

Publication:

Community Mental Health Journal, 39(4), 333-347.

Volume:

Number:

Pages:

333-347

Publisher:

Springer Science+Business Media

Background:

High unemployment rates are found in people with long-term mental health problems although they want to work. Various approaches to increasing access to work have been described. Currently evidence favors the individual placement and support (IPS) model. Here the aim is to help patients obtain open employment with a minimal period of pre-vocational training; a place-train approach rather than vice versa. Once a job or training place has been obtained as much support as possible is given with the aim of retaining the position. This model is gaining increasing recognition in the United States and a Cochrane review concluded that it was more effective than pre-vocational training in helping people with severe mental illness return to work. However mental health services in Europe have been slower to prioritize this issue.

Purpose:

To investigate the impact of training Community Mental Health Team members in the practice of Individual Placement and Support on the vocational status of long-term patients.

Setting:

Subjects were recruited from ten Community Mental Health Teams of a large London Mental Health Trust. Subjects were eligible for inclusion if they had been in continuous contact with their Community Mental Health Team for at least one year and were unemployed. All subjects were
over the age of 16. Males over 65 and females over 60 (normal retirement age) were excluded from the study.

Sample:

Six Community Mental Health Teams received vocational training by a work co-coordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified.

Data Collection:

Data were entered into SPSS for windows version 10 and cleaned using logical searches. The data were analyzed without adjustment for the cluster design. This was because the inter-cluster correlation coefficient (ICC) was 0.00148, which leads to a design effect of 1.01. The small ICC means that individual behavior is only affected to a minor degree by cluster membership, meaning that the cluster design has little overall effect. To test any effect of the intervention the categorical variables were analyzed using tests and continuous variables were analyzed using independent t-tests. A stratified chi-square analysis was conducted to allow for differences between the groups at baseline. When examining factors associated with return to work differences within categories were compared using the z-test. For all statistical tests a significant p-value was set at 0.05.

Intervention:

This was a randomised controlled trial of the effect of training of Community Mental Health Team members on the vocational needs of long-term patients. The training and provision of information was by a Consultant Clinical Psychologist specialising in vocational rehabilitation (RP)and a work coordinator with experience in supported employment. The unit of randomization was the team rather than the patient. Local Research Ethics Committee approval was obtained for the study, which did not require written consent from individual patients.

Control:

The control condition was high quality standard Community Mental Health Team care.

Findings:

There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome.

Conclusions:

Training in Individual Placement and support at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful Individual Placement and Support.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/12908647

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes

Authors:

O'Brien, A., Price, C., Burns, T., & Perkins, R.

Year Published:

2011

Publication:

Scandinavian Journal of Caring Sciences, 25(3), 591-598.

Volume:

Number:

Pages:

591-598

Publisher:

Nordic College of Caring Science

Background:

Lack of participation in the open labor market is highly prevalent for people with a mental illness across countries, and the proportion of people who get some kind of sickness benefit because of mental illness is steadily growing in Europe.

Purpose:

Vocational rehabilitation through individual placement and support (IPS) model has been shown to be effective and is evidence-based for people with severe mental illness. In Sweden, the method is used but not scientifically evaluated. The aim was to investigate vocational and nonvocational outcomes at a 1-year follow-up and the relationships between these outcomes, at two different sites in the north of Sweden.

Setting:

The study was designed as a follow-up of clients included in two SE services for people with a mental illness. Assessments were made at baseline, and at 1-year and 2-year follow-ups. In addition, service use and vocational situation were registered at 2-monthly intervals during the follow-up period. One of these services is situated in a town of 115,000 inhabitants, and the other team is situated in a town where 70,000 people live. Both teams are organized in the municipalities social service organization as time-limited projects. They are financed by a coordinating organization, where representatives of the employment office, social insurance bureau, psychiatric service and the local social service are members.

Sample:

The participants were 65 men and women, mostly younger than 30 years of age and with a mental illness. Occupational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning were assessed. Assessments included vocational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning. The present paper includes results from the 1-year follow-up.

Data Collection:

The clients were contacted by the first author as soon as possible after inclusion in the programme. The clients were given the opportunity to choose where the data collection would take place and this was usually at the SE office. However, but some interviews were held in the client‚ residence or in the first author‚ office at the university. In most cases, the data collection lasted for 60‚Äì90 minutes to complete the questionnaires.

Intervention:

Individual Placement and Support (IPS) model is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice.

Control:

There was no control or comparison condition.

Findings:

The vocational outcome during 1 year was that 25% of the participants were employed, and 14% were in education. Most of the participants moved from unemployment to work practice for a prolonged time. Participants in employment, education or work practice at follow-up showed higher satisfaction with their occupational situation than those without regular activities outside home. Among the participants in work practice, improvements in psychiatric symptoms and global functioning were identified.

Conclusions:

This attempt is the first to evaluate supported employment according to the IPS model for persons with mental illness applied in the Swedish welfare system. There is a need for a longer follow-up period to evaluate whether interventions such as further education and work practice actually will lead to real work.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/21323690

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: A pilot study

Authors:

Noel, V. A., Oulvey, E., Frake, R. E., & Bond, G. R.

Year Published:

2006

Publication:

Journal of Occupational Rehabilitation

Volume:

Number:

Pages:

647-657

Publisher:

Springer Science+Business Media, LLC

Background:

Return to work continues to be a challenge among providers and cancer survivors. Cancer patients are a risk for unemployment, due to the long term side effects of cancer and related treatments. Some forms of cancer are chronic diseases and can negatively impact a person's quality of life and lead to long term problems such as fatigue, pain, depression and other functional limitations. The loss of work can further impact quality of life due to loss of income and negative impact on self esteem. Employers and society are also impacted. Cancer survivors tend to get little advice on return to work from the medical community. Work related interventions are limited and the quality of existing studies is only moderate. Interventions are needed to improve return to work outcomes for cancer survivors.

Purpose:

The purpose of this study is to determine if enhancing communication between the attending and the occupational physicians about a patient's status or providing educational materials with advice on return to work to a patient will enhance the individual's employment outcome.

Setting:

Patients were recruited from the radiotherapy department at the a large medical center in the Netherlands.

Sample:

Thirty five patients, who had a prognosis of at least 80% chance of two year survival and who were employed at the time of diagnosis, were enrolled in the study. Twenty six were able to be interviewed.

Data Collection:

A self administered baseline questionnaire was completed by patients. The overall score on 8 items that were predictive of return to work, according to a previous cohort study, was treated as a predictor of return to work. Variables included:age, gender, diagnosis, type of cancer treatment, depressed mood, physical complaints, physical workload and fatigue. Additionally, satisfaction on the advice from the educational materials was gained during a semi-structured interview. At this time the participants rated the materials on a scale of one (very poor) to 10(very good). Satisfaction with each of the 10 steps, (ie.adherence to the advice), was also rated as useful, somewhat useful, not useful or redundant. Occupational physicians were also interviewed about their satisfaction and perceived influence of the letters and educational material.

Intervention:

There were 2 interventions. First the radiation oncologist sent two letters to the general practitioner. The first letter was sent at the onset of treatment. The second letter was sent at the conclusion of the treatment and included information on the patient's outcome. Copies of the two letters were also sent to the occupational physician. In the second intervention the radiation oncologist gave the patient educational material that offered ten steps to enhance a patient's return to work. A copy of the leaflet was also sent to the occupational physician along with the second letter sent by the radiation oncologist.

Control:

In this study the subjects served as their own comparison group in pretest/post-test.

Findings:

Among the 24 occupational physicians interviewed, 22 considered the information provided in the letters as "helpful". Fifty percent indicated the information influenced their rehabilitation efforts. In particular, this group noted the information on diagnosis and treatment as particularly useful. The educational leaflet was rated on a scale of 1 to 10 as 7.3 with SD of 1.0. Patients were also interviewed after treatment. They gave the educational leaflet a mean score of 7.9 with SD of 0.6. Scores ranges for this group from 6.5 to 10. Not all who rated the advice as useful, acted upon it. Time from ending treatment to return to work ranged from 0 to 133 days. After 6 months 65% of the patients had returned to work. And by month 18,92% of the sample had returned to work.

Conclusions:

The pilot shows encouraging results on the use of the interventions to assist individuals with cancer with returning to work. Large randomized controlled trials are needed.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/17063404

Populations:

Outcomes:

Return to work

NIDILRR Funded:

Research Design: