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1. Understand factors that can impact work

Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Step 1 of 11 in getting ready to return to work:

There are many factors that impact a cancer survivors’ chances for a successful return to work. Understanding facilitators and barriers that can ease or hinder their return to work can help determine what needs to be addressed. The Vocational Rehabilitation Model for Cancer Survivors identifies four factors biopsychosocial, person-centered, system and worksite factors) that can guide your assessment and help you determine how you can help a cancer survivor with return to work. Once your assessment of factors is complete, your review will better enable you to work with your patients to determine their goals, provide or advocate for care, and help them navigate their return to work.

Vocational Rehabilitation Model for Cancer Survivors: Four Factors
(Parkinson & Maheu, 2019)

Vocational Rehabilitation Model for Cancer Survivors

In the Vocational Rehabilitation Model for Cancer Survivors, there are four factors that interact to influence the RTW process and the person’s workability. These are biopsychological, person-related, systems and work-site factors.
 
Biopsychological

Here, the assessment looks at what are the biological and psychological factors that can proceed, emerge or continue on after diagnosis and treatment, such as a pre-existing disability and cancer and treatment-specific factors and late and long-term effects of these. Further in the assessment is seeing how these factors can impact recovery and whether physical, psychological and cognitive disabilities are temporary, long-lasting, or permanent?   

Here are examples of how bio-psychological factors impact on the cancer survivors’ workability.

Example 1: A cancer survivor now finds that his neuropathy in his hands is not improving and as a result, he is unable to type on a keyboard.

Example 2: Because of learning difficulties unrelated to cancer, a cancer survivor has previously chosen work as a laborer. She is now unable to do the heavy work required of this job but does not think she can handle formal schooling because of her learning challenges.

Example 3: A cancer survivor has ongoing problems with low mood, concentration, word-finding, and memory and feels managing others in a busy work setting may be challenging to do.

Person-related Factors

Many cancer survivors often describe a change in the meaning, priorities, motivation with reference to work. Several person-related factors are likely to impact their ability, access and willingness to return to work . In your assessment of person-related factors, you will want to assess:

What are the cancer survivor’s feelings about their job, feelings of self-efficacy, and the demographic factors unique to them that may influence return to work.

What are the cancer survivor’s perceptions of work (views of the meaning of work, motivations and/or importance of work), whether they view work as positive, negative or healthy and their expectations of recovery with respect to work.

What are the demographic factors such as age, gender, and education that might influence access to work?

Example 1: A cancer survivor feels that stress caused his cancer and feels the main source of stress comes from work. He, therefore, is afraid to return to work for fear this will increase his chances of getting a recurrence of his cancer.

Example 2: A survivor wants to continue working during treatment because she feels working allows to stay connected to colleagues to prevent her from feeling socially isolated.

Example 3: The cancer survivor is an older worker and is concerned that his employer will be less keen to have him back because the temporary replacement worker in his job is younger and is paid at a lower income.

Systems Factors

What are the influences of systems such as the health care services, insurance providers, community agencies, legislative supports and social and family networks? Navigating systems can be both a positive and negative experience that can assist, delay or impede in a person’s ability to return to work. For example influences from the healthcare services can include timely access to treatments, symptom management, rehabilitation and even views of the health care provider about whether a cancer survivor is able to work. The support by an insurance provider such as income support (how much and for how long) and funding for rehabilitation support can influence return to work. Family influences such as competing demands (such as caregiving) and family support can influence return to work. System influences can also include the legal support to help job retention. For more information on legislative support see: https://www.cancerandwork.ca/healthcare-providers/law-policy-and-practice-information/

Example 1: A breast cancer survivor wants to delay returning to work until she has reconstructive surgery which is scheduled in 4 months.

Example 2: A cancer survivor has access to funding for an exercise program through a long- term disability provider to help to restore physical work ability sooner.

Example 3: A cancer survivor is worried that if she takes too much time off for treatment she will not have the legal protection to retain her job.

Worksite Factors

What are the job demands (physical, psychological, and cognitive), work hours (part- time/full time, evening/days), availability of accommodations, workplace relationships (with employers and colleagues) and access to return to work support such as rehabilitation and disability management at the workplace?

Example 1: The job is very physically demanding and the cancer survivor has lost conditioning and suffers from fatigue. The employer has allowed her to do lighter duties.

Example 2: The cancer survivor is currently unable to do full time work and the employer has allowed for a graduated return to work.

Example 3: The cancer survivor is concerned that she will not be supported during her return to work because some coworkers do not like him.

By exploring the biopsychological, person centered, system and work site factors with the cancer survivors, as a health care provider you will be better able to understand what needs to be addressed and be better prepared to work with the cancer survivor for challenges and capitalize on resources to support a successful return to work.

For more information see:

Parkinson, M., & Maheu, C. (2019). Cancer and work. Canadian Oncology Nursing Journal = Revue Canadienne De Nursing Oncologique, 29(4), 258-266. http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1019

Next step:

Step 2: Assess function

Back to the list of return to work preparation steps