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Rehabilitation and return to work after cancer — how could instruments and practices support workers and employers?

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Rehabilitation and return to work after cancer — how could instruments and practices support workers and employers?

  1. 1. Safety and health at work is everyone’s concern. It’s good for you. It’s good for business. Rehabilitation and return to work after cancer — how could instruments and practices support workers and employers? Focus: non-OSH experts
  2. 2. 2 http://osha.europa.eu Content  Background  Impact of cancer diagnosis on work  Overview of instruments, practices, policies and interventions  Innovative instruments, practices, policies and interventions  Programmes in enterprises and employers’ experiences  Implementation of instruments, practices, policies and interventions — barriers  Implementation of instruments, practices, policies and interventions — facilitators  Recommendations
  3. 3. 3 http://osha.europa.eu Background: employment after a cancer diagnosis  Increase in the number of workers diagnosed with cancer at the workplace • Number of cancer patients of working age is increasing • Better treatment and higher survival rates • Increasing retirement age • Ageing working population • 3.4 million new cases of cancer each year in Europe • Of which 1.4 million people are of working age each year  RTW after cancer is important • Worker − Quality of life for cancer patients − Income and insurance − Structure in normal life and social contacts • Employer − Keep experienced workers in companies − Reduce financial impact on companies and society
  4. 4. 4 http://osha.europa.eu Background: RTW after a cancer diagnosis is important  Therefore, optimising the rehabilitation and RTW of workers with cancer is essential  Providing cancer patients with policies, programmes and instruments to support their RTW process is important • Modifiable factors provide opportunities for interventions • Despite a limited number of interventions, little is known about: − their success factors − facilitators of their implementation in other settings − barriers to their implementation in other settings • Policies and practices are needed to avoid problems • Employers need advice in assisting the worker affected by cancer while returning to work
  5. 5. 5 http://osha.europa.eu Impact of cancer diagnosis on work: health implications and costs  Health and safety implications for workers affected by cancer • Effects of cancer and its treatment on health: − Psychological and cognitive symptoms, e.g. depression, anxiety and concentration problems − Physical symptoms: mainly fatigue • Occupational implications: − Diminished work productivity − Work ability impairments and reduced functioning  Costs for workers, employers and society • Sick leave and no RTW: − Financial loss for the worker, the employer and society • Total economic loss to the European Union owing to lost working days as a result of cancer: €9.5 billion in 2009 https://osha.europa.eu/en/tools-and-publications/publications/rehabilitation-and-return-work-after-cancer-literature-review
  6. 6. 6 http://osha.europa.eu Impact of cancer diagnosis on work: occupational cancer and SMEs  Work-related and occupational cancer • RTW issues seem to be no different from those concerning non-occupational cancers − Most occupational cancers have long latency − Exposure to carcinogens at work may be unknown  Small and medium-sized enterprises (SMEs) • RTW of cancer patients seems more problematic for those in SMEs • Barriers − Information and resources for RTW programmes are lacking − Fewer alternative jobs and tasks • Facilitators − Family-like atmosphere: more supportive environment https://osha.europa.eu/en/tools-and-publications/publications/rehabilitation-and-return-work-after-cancer-literature-review
  7. 7. 7 http://osha.europa.eu Overview of instruments, practices, policies and interventions  Aimed at workers • Workplace accommodations, including: − workload − tasks − assistance • Information and training on cancer and RTW issues • Psycho-educational interventions • Rehabilitation services • Job coaching  Aimed at employers • Support for employers in constructing RTW plans for employees with cancer • Workplace accommodations to facilitate RTW • Improved communication between the employee and co-workers • Factual information on diagnosis and treatment of cancer • Guidelines
  8. 8. 8 http://osha.europa.eu Innovative interventions: Macmillan and municipality-based programme 1. Working through cancer programme of Macmillan Cancer Support (UK) • Online information, support, training, tools, videos • Help for different stakeholders − people with cancer and their family/carers − health and social care professionals − employers 2. Municipality-based occupational rehabilitation programme (Denmark) • Individual, tailored to worker’s needs • Involves different stakeholders: − hospital (nurses) − employer − job consultant − worker
  9. 9. 9 http://osha.europa.eu Innovative interventions: in-hospital and work reintegration agencies 3. In-hospital rehabilitation intervention (the Netherlands) • Early intervention • Involves different stakeholders 4. Work reintegration agency Rentree (Belgium) • Involving different stakeholders • Worker chooses who is involved in the RTW process • Tailored to the worker 5. Work reintegration agency Re-turn (the Netherlands) • Includes issues regarding work, home, family, relationships and physical/mental effects of treatment and RTW • Involves different stakeholders
  10. 10. 10 http://osha.europa.eu Innovative interventions: work reintegration agency and booklet 6. Work reintegration agency oPuce (the Netherlands) • Provides help for unemployed cancer patients • Results in new jobs for unemployed cancer patients • Works together with large companies 7. Booklet of the Irish Congress of Trade Unions (Ireland) • Aiming at: − Breaking the stigma of cancer and RTW − Encouraging good conversations between the employer and worker − Providing assistance to unions who are representing members diagnosed with breast cancer who are returning to work
  11. 11. 11 http://osha.europa.eu RTW process: role of employers and the importance of communication  Employers are key stakeholders in the RTW process • They are in a position to create good working conditions • They can reduce discrimination and stigmatisation • They help minimise the economic impact of a cancer diagnosis  Communication between companies and workers • Depends on the size of the company − In small companies, the communication lines seem to be shorter and the worker is likely to be informed sooner • Depends on the situation of the worker, including the severity of the medical diagnosis and their personal preferences
  12. 12. 12 http://osha.europa.eu RTW programmes for occupational and work-related cancer and for SMEs  Employers’ positive attitude and understanding is crucial  Lack of programmes aimed at RTW for workers with occupational and work-related cancer  Companies with fewer than 250 workers (SMEs) lack information and resources for RTW strategies or programmes
  13. 13. 13 http://osha.europa.eu Implementation of instruments, practices, policies and interventions — barriers  Barriers • Companies being unable to provide work adjustments • Occupational healthcare after treatment phase not being covered by the health insurer • Cultural stigma of a cancer diagnosis • Cultural misconceptions about working after a cancer diagnosis • Lack of time • Financial difficulties • Privacy legislation that hinders open communication • Attending physicians being too protective regarding RTW
  14. 14. 14 http://osha.europa.eu Implementation of instruments, practices, policies and interventions — facilitators  Facilitators • Communication with worker and between stakeholders • Knowledge among HR personnel and supervisors on cancer and work • Company’s positive policy and attitude • Structural implementation of an RTW programme within the company • Legal possibilities of offering part-time work • Clarity regarding responsibility • Knowledge and sufficient skills at the workplace to support the RTW of the worker with cancer • Failure to address work immediately from the start of treatment
  15. 15. 15 http://osha.europa.eu Recommendations for practice  Allocate enough time for the RTW process  Allocate training • in knowledge of cancer and work aspects • in skills regarding elements of the RTW programme  Ensure occupational health physician has access to the worker  Occupational health physician should support both the worker and the employer early in the diagnosis and treatment process  Provide practical information regarding, for example, reasonable accommodation Employer: ‘And then also making sure our HR people are crystal clear about our expectations in this regard so that they can support line managers.’ Employer: ‘Workers have access to the policy at any time. They know what their sickness payment entitlement is but we would more likely talk to them than send them a policy. Everyone is so different and everyone’s needs are so different, it’s not something that lends itself, other than the policy, it doesn’t really lend itself to being written down because everything is so individual.’ Employer: ‘We need to train line managers. The training is about, you know, being an engaging manager but, obviously, our approach to people is a core part of the training, in terms of respecting people, people’s health and safety at the workplace, and familiarising, making sure managers are familiar with our policies.’
  16. 16. 16 http://osha.europa.eu Recommendations for practice  Open communication between the worker, employer and other stakeholders involved  It should be mandatory for employers to offer RTW interventions or programmes to workers  SMEs should be helped by occupational health services to make work requirements more flexible  SMEs should align with other companies that have more flexible jobs  Note the privacy rights of the worker Employer: ‘If occupational health thinks that somebody would benefit from counselling, we refer the worker to the Employee Assistance Programme. And then again, if somebody doesn’t want to be counselled, we can’t force them to go to counselling. We can strongly recommend it but we can’t force them. We do encourage people to use the Employee Assistance Programme to unload, you know, where possible.’
  17. 17. 17 http://osha.europa.eu Recommendations for practice  Assess the worker’s needs and tailor the programme to the worker’s needs  Stay in contact with the worker Worker: ‘My main point of contact was the head of HR. I mean, that was my choice. When I walked out of work, I really didn't want to be talking to multiple people. I just worked through the HR head, that made it easier. I kept like professionally work updated through her, with her head of HR hat on and then my colleagues updated through her as well.’ Employer: ‘Typically a home visit would always be with an HR person, and sometimes the worker might come into the office, and sometimes they might arrange to meet somewhere neutral like a coffee shop or whatever. So it can vary and its very much driven by the individual and whatever they are comfortable with and some people don’t want their line manager sitting on a sofa drinking coffee, they just don’t want it, they would rather come into the office or have a phone conversation or an email.’

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