The perceived importance of prognostic aspects considered by physicians during work disability evaluation: a survey.

BACKGROUND: Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment. METHODS: Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both "in general" and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses. RESULTS: Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0-9.0), with less differing opinions among participants (IQR 1.0-3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0-8.0, with IQR 2.0-5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence. CONCLUSIONS: Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.

Assessment of prognosis by physicians involved in work disability evaluation: A qualitative study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.