Use of a Decision Support Tool on Prognosis of Work Ability in Work Disability Assessments: An Experimental Study Among Insurance Physicians.

Purpose Assessment of prognosis of work disability is a challenging task for occupational health professionals. An evidence-based decision support tool, based on a prediction model, could aid professionals in the decision-making process. This study aimed to evaluate the efficacy of such a tool on Dutch insurance physicians' (IPs) prognosis of work ability and their prognostic confidence, and assess IPs' attitudes towards use of the tool. Methods We conducted an experimental study including six case vignettes among 29 IPs. For each vignette, IPs first specified their own prognosis of future work ability and prognostic confidence. Next, IPs were informed about the outcome of the prediction model and asked whether this changed their initial prognosis and prognostic confidence. Finally, respondents reported their attitude towards use of the tool in real practice. Results The concordance between IPs' prognosis and the outcome of the prediction model was low: IPs' prognosis was more positive in 72 (41%) and more negative in 20 (11%) cases. Using the decision support tool, IPs changed their prognosis in only 13% of the cases. IPs prognostic confidence decreased when prognosis was discordant, and remained unchanged when it was concordant. Concerning attitudes towards use, the wish to know more about the tool was considered as the main barrier. Conclusion The efficacy of the tool on IPs' prognosis of work ability and their prognostic confidence was low. Although the perceived barriers were overall limited, only a minority of the IPs indicated that they would be willing to use the tool in practice.

A typology of sick-listed claimants to improve communication skills for social insurance physicians during medical disability assessment interviews.

INTRODUCTION: Role play with standardised simulated patients is often included in communication training. However, regarding physician-patient encounters in medical disability assessment interviews it is unclear what should be included in the scenarios for actors. The first objective of this study was to determine which types of medical disability claimants can be distinguished based on behavioural determinants. The second objective was to determine if these types of claimants differed in their perception of communication behaviour and their satisfaction with the communication with physicians. METHODS: Questionnaire data were collected from 56 Dutch claimants for 13 behavioural determinants before their assessment interview, and for 12 behavioural and satisfaction variables afterwards. For the first objective cluster analyses were performed and for the second objective linear regression analyses were performed. RESULTS: The results showed that three types of claimants could be distinguished: insecure support-seeking claimants, confident claimants, and socially isolated claimants. Overall, claimants were positive about the communication with the physician: insecure support-seeking claimants were satisfied and confident claimants were highly satisfied, but socially isolated claimants were unsatisfied. CONCLUSION: Scenarios for standardised simulated patients should include different types of claimants. In training, special attention should be given to communication with socially isolated claimants.

Stereotyping of medical disability claimants' communication behaviour by physicians: towards more focused education for social insurance physicians.

BACKGROUND: Physicians who hold medical disability assessment interviews (social insurance physicians) are probably influenced by stereotypes of claimants, especially because they have limited time available and they have to make complicated decisions. Because little is known about the influences of stereotyping on assessment interviews, the objectives of this paper were to qualitatively investigate: (1) the content of stereotypes used to classify claimants with regard to the way in which they communicate; (2) the origins of such stereotypes; (3) the advantages and disadvantages of stereotyping in assessment interviews; and (4) how social insurance physicians minimise the undesirable influences of negative stereotyping. METHODS: Data were collected during three focus group meetings with social insurance physicians who hold medical disability assessment interviews with sick-listed employees (i.e. claimants). The participants also completed a questionnaire about demographic characteristics. The data were qualitatively analysed in Atlas.ti in four steps, according to the grounded theory and the principle of constant comparison. RESULTS: A total of 22 social insurance physicians participated. Based on their responses, a claimant's communication was classified with regard to the degree of respect and acceptance in the physician-claimant relationship, and the degree of dominance. Most of the social insurance physicians reported that they classify claimants in general groups, and use these classifications to adapt their own communication behaviour. Moreover, the social insurance physicians revealed that their stereotypes originate from information in the claimants' files and first impressions. The main advantages of stereotyping were that this provides a framework for the assessment interview, it can save time, and it is interesting to check whether the stereotype is correct. Disadvantages of stereotyping were that the stereotypes often prove incorrect, they do not give the complete picture, and the claimant's behaviour changes constantly. Social insurance physicians try to minimise the undesirable influences of stereotypes by being aware of counter transference, making formal assessments, staying neutral to the best of their ability, and being compassionate. CONCLUSIONS: We concluded that social insurance physicians adapt their communication style to the degree of respect and dominance of claimants in the physician-claimant relationship, but they try to minimise the undesirable influences of stereotypes in assessment interviews. It is recommended that this issue should be addressed in communication skills training.