Healthcare professionals’ work with sickness absence : with focus on oncology

Background: Physicians have an important role in patients’ sickness absence (SA) process, and many initiatives have been taken to influence their sickness certification practice. Many physicians experience sickness certification as a problematic task. This also applies to oncologists, a group in which a larger proportion has sickness certification tasks more often compared to physicians with other specialties. Experiences of encounters with healthcare professionals is one factor that has been shown to be of importance regarding SA and ability to return to work (RTW) among sickness absentees in general. Breast cancer (BC) is the most common cancer among women of working age, however, knowledge about their experiences of encounters with healthcare professionals regarding SA and work is scarce.

Aim: To increase the knowledge about healthcare professionals’ work with SA, how women with BC experience encounters with healthcare professionals, and possible associations with SA and RTW.

Method: In study I-III, data from three different Swedish surveys were analyzed. Study I: 342 oncologists who had sickness certification consultations were included. Study II: A cohort of 690 women in Stockholm, who had had surgery for primary BC, and were aged 24-63 years were included. Study III: A random sample of 6197 women in Sweden, aged 19-65 years, and on SA since 4-8 months were included. Of those, 187 were on SA due to BC. In study I-III, descriptive statistics were calculated, and logistic regression with odds ratios (OR) with 95% confidence intervals (CI) were used for analyses of associations. Study IV: A systematic literature review of interventions regarding physicians’ sickness certification practices. Metaanalyses were performed to produce summarized relative risk estimates with 95% CI from the data pooled using random effect models.

Results: Study I: A majority of the oncologists had consultations involving sickness certification weekly and one fifth experienced such consultations as problematic at least once a week. Associations were found between oncologists stating not having enough organizational resources for work with such tasks and experiencing different aspects of sickness certification as problematic. Study II: A majority of the women with BC had experienced encounters regarding work with healthcare. An association was found both between women having experienced advice and support regarding work and having been encouraged to work and having less SA, as well as between to have been encouraged to be on SA and having more SA. The latter was partly explained by disease and treatment factors. Study III: Positive encounters with healthcare professionals in connection to SA were experienced by almost all the women on SA, both women with BC and with other SA diagnoses. About half of the women stated that positive encounters promoted their ability to RTW, slightly fewer among women with BC. Four specific types of encounters; “allowed me to take own responsibility”, “encouraged me to carry through my own solutions”, “made reasonably high demands”, and “sided with me/stood on my side” were also experienced to a lesser extent by women with BC. Study IV: Nine intervention studies were included. The effect measures varied considerably. Significant intervention effects in intended direction were found in four of the nine interventions, in two interventions unintended effects were found. The meta-analyses indicated a summarized effect on any RTW (first, partial or full) among the patients.

Conclusion: Although oncologists often had sickness certification tasks, such tasks were seldom experienced as problematic. However, lack of resources for sickness certification tasks was associated with experiencing such tasks as problematic. Most of the women with BC had experienced encounters from healthcare professionals regarding work and SA the year after the surgery. Most of the women, both on SA due to BC or due to other diagnoses, had experienced positive encounters, and that such encounters promoted being able to RTW. The results indicate that physicians’ sickness certification practice can be influenced by interventions.

List of scientific papers

I. Söderman M, Wennman-Larsen A, Alexanderson K, Veronica Svärd, Friberg E. Physicians’ experiences of, and prerequisites for sickness certification tasks at oncolgy clinics: a nationwide survey study. [Submitted]

II. Söderman M, Friberg E, Alexanderson K, Wennman-Larsen A. Women's experiences of encounters with healthcare professionals' regarding work after breast-cancer surgery and associations with sickness absence: a 2-year followup cohort study. Supportive Care in Cancer. 2019;27(4):1197-206.
https://doi.org/10.1007/s00520-018-4453-1

III. Söderman M, Wennman-Larsen A, Alexanderson K, Friberg E. Experiences of positive encounters with healthcare professionals among women on longterm sickness absence due to breast cancer or due to other diagnoses: a nationwide survey. BMC Public Health. 2019;19(1):349.
https://doi.org/10.1186/s12889-019-6666-8

IV. Söderman M, Wennman-Larsen A, Hoving JL, Alexanderson K, Friberg E. Interventions regarding physicians’ sickness certification practices – a systematic literature review with meta-analysis. [Manuscript]