Amsterdam UMC, Location AMC, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands.
PLoS One. 2019 Feb 8;14(2):e0212276. doi: 10.1371/journal.pone.0212276. eCollection 2019.
Assessment of prognosis of work functioning is a challenging aspect of work disability evaluations. To gain insight into this process, we conducted a qualitative study to determine the aspects considered and the difficulties, needs and potential solutions affecting the prognosis assessment by physicians performing disability evaluations.
In-depth, semi-structured individual interviews were conducted with 20 physicians performing disability evaluations for the Dutch social security institute: the national institute for employee benefit schemes. Verbatim transcripts were independently analyzed by two researchers using MAXQDA software until significant themes emerged and data saturation was achieved.
The responses that emerged from the interviews were clustered in three primary themes. The first theme was "Aspects considered by physicians in assessing prognosis." When making a prognosis, physicians considered the following medical issues: nature and severity of disease, the role of treatment, course of the disease, external information, and medical evidence. Patient-related issues and physician-related aspects were also distinguished. Patient-related aspects concerned the patients' work perspectives and coping or recovery behavior. Physician-related aspects concerned awareness of the physician's own role and reflection on aspects such as empathy for clients and ethical considerations. The second theme was "Difficulties physicians face in assessing prognosis," which included challenges during the assessment of diseases of a complex or less concrete nature, applying prognostic evidence to the individual, and lack of time when seeking prognostic evidence. The third theme concerned "Needs and solutions" formulated by physicians that facilitated the prognostic assessment. It consisted of continuous education, better collaboration with medical specialists and/or labor experts, and the use of prognostic tools such as checklists, apps or internet applications incorporating evidence on prognosis.
Physicians identified several medical and patient-related aspects that elucidated the prognosis assessment. Given the variety of challenges and the need for further support found in the current study, future research should focus on the development and evaluation of training, tools, and guidelines to improve prognosis assessment by physicians.
评估工作功能的预后是工作能力丧失评估的一个具有挑战性的方面。为了深入了解这一过程，我们进行了一项定性研究，以确定进行残疾评估的医生在进行预后评估时考虑的方面、面临的困难、需求和潜在的解决方案。
对 20 名为荷兰社会保障机构（国家雇员福利计划研究所）进行残疾评估的医生进行了深入的半结构化个体访谈。两位研究人员使用 MAXQDA 软件对逐字记录进行了独立分析，直到出现显著主题并达到数据饱和。
访谈中出现的回复分为三个主要主题。第一个主题是“医生在评估预后时考虑的方面”。在进行预后评估时，医生考虑了以下医学问题：疾病的性质和严重程度、治疗的作用、疾病的过程、外部信息和医学证据。还区分了与患者相关的问题和与医生相关的方面。与患者相关的方面涉及患者的工作前景和应对或康复行为。与医生相关的方面涉及医生对自己角色的认识以及对同理心和道德考量等方面的反思。第二个主题是“医生在评估预后时面临的困难”，包括在评估性质复杂或不太具体的疾病时面临的挑战、将预后证据应用于个体以及在寻找预后证据时缺乏时间。第三个主题是“医生提出的促进预后评估的需求和解决方案”。它包括继续教育、与医学专家和/或劳动专家更好的合作，以及使用预后工具，如检查表、应用程序或包含预后证据的互联网应用程序。
医生确定了一些与医疗和患者相关的方面，这些方面阐明了预后评估。鉴于当前研究中发现的各种挑战和对进一步支持的需求，未来的研究应侧重于开发和评估培训、工具和指南，以提高医生的预后评估能力。
