Towards person-centred work-focused healthcare for people with cardiovascular disease: a qualitative exploration of patients’ experiences and needs

Figures & data

Table 1. Demographic characteristics of the participants (n = 19).

Variable	Mean (SD) or n (percentage)
Age	54.3 (10.8)
Gender (male)	16 (84%)
Time since diagnosis (years)	2.1 (1.4)
Type of CVD
Cardiac arrest	1(5.3%)
Cardiac sarcoidosis	2 (10.5%)
Endocarditis	1 (5.3%)
Heart failure	2 (10.5%)
Heart rhythm disorder	2 (10.5%)
MINOCA	2 (10.5%)
Pericarditis	2 (10.5%)
Stroke (multiple)	7 (36.8%)
Type of work agreement*
Self-employed	2 (10.5%)
Contracted employee	15 (79.0%)
Temporary worker	1 (5.3%)
Temporary agency worker	1 (5.3%)
Job sector
Education and training	2 (10.5%)
Engineering, production and  construction	1 (5.3%)
Healthcare and wellbeing	4 (21.1%)
Security and public administration	3 (15.8%)
Trade and services	4 (21.1%)
Tourism, recreation and catering	1 (5.3%)
Transport and logistics	4 (21.1%)
Work status**
Fully returned to work	7 (36.8%)
Partly returned to work	4 (21.1%)
Full sick leave	8 (42.1%)

SD, standard deviation; CVD, cardiovascular disease; MINOCA, myocardial infarction with non-obstructive coronary arteries.*At the moment of diagnosis/start medical intervention. **At the moment of the interview.

Figure 1. Graphical representation of the adapted principles of Picker for person-centred work-focused healthcare. Changes to the original Picker Principles are indicated in italics [23].

Table 2. Overview of the identified themes for each of the eight adapted picker principles for person-centred care including representative quotes.

THEME DESCRIBING THE NEED	RESPRESENTATIVE QUOTE
1) ACCESS TO RELIABLE HEALTHCARE THAT SUPPORTS WORK PARTICIPATION.
Tailored start of occupational healthcare provision	“At a certain moment, you recognize that you are feeling better, and you can think about work again. When I reach that point, I am curious about the opinion of [the occupational healthcare professional].” - PT 9 (male, 61, contracted employee, full sick leave)
Frequent encounters with occupational healthcare professionals	“[The occupational healthcare professional] really had the time to observe my development over time, which helped in making a decision about [my future work ability].” - PT 15 (male, 35, contracted employee, partly returned to work)
Timely notification on the outcome of occupational healthcare assessment and/or guidance	“Bizarre. How [the occupational healthcare professional] (..) can assess [your work ability] within half an hour. (..) I really had no idea which way [the disability assessment] was going.” - PT 12 (female, 46, contracted employee, partly returned to work)
Ongoing support after successful RTW	“I thought it was a shame that there was no follow-up [after full RTW]. How things went from that moment on. You have to figure it out yourself.” - PT 19 (male, 62, contracted employee, partly returned to work)
2) EFFECTIVE WORK-FOCUSED HEALTHCARE DELIVERED BY TRUSTED PROFESSIONALS.
Knowledge of CVD within occupational healthcare	“[The clinical care professional] knows all about [my health problem]. (..) When you ask [the cardiologist] what you can do or cannot do, you get an answer you can rely on.” - PT 1 (male, 28, contracted employee, fully returned to work)
Work-related advice within clinical care	“Of course, [the clinical care professional] [informed me] what I could still do, the status of my heart, and how much time I could work. We talked a lot about this during [the first sick leave] period.” - PT 15 (male, 35, contracted employee, partly returned to work)
Substantive work-related advice	“The only tip I received [from the occupational healthcare professional] was: ‘keep moving (..)’. Some general comments, I could have come up with that myself.” - PT 18 (male, 65, temporary agency worker, full sick leave)
Psychological counselling	“I feel way too young for this, I had a fantastic job (..), I had different plans for the future, and then everything collapses. (..) you simply need support on a psychological level as well. (..) With my psychologist, I am currently in a process of acceptance” - PT 6 (male, 57, contracted employee, full sick leave)
Legal guidance	“At the moment you are back home [after hospitalisation and start of your sick leave], it is really frustrating that you are not aware of your rights, (..) you do not know what you can do to stand up for yourself.” - PT 6 (male, 57, contracted employee, full sick leave)
3) CONTINUITY OF CARE AND SMOOTH TRANSITIONS BETWEEN ALL PROFESSIONALS INVOLVED IN THE FULL CYCLE OF WORK-FOCUSED HEALTHCARE.
Transparency in communication	“I do not know if my employer also received the report from the SSA. A report that informs the employer about what they should pay attention to. I have no idea, but I hope that was the case.” – PT 12 (female, 46, contracted employee, partly returned to work)
Consistency in the provided information	“[My rehabilitation professional] drew up a report [about his view on my work ability], (..) and sent it to [the occupational healthcare professional] by email. But [the occupational healthcare professional] disregarded the report. She just did what she thought was the right thing to do.” - PT 19 (male, 62, contracted employee, partly returned to work)
Interdisciplinary teamwork	“[The occupational healthcare professional] only has one interest: how to get my patient back to work as soon as possible? While [the clinical care professional] had the goal of: How can I get my patient better again? There are all kinds of interests.” - PT 6 (male, 57, contracted employee, full sick leave)
Permanent professional	“I simply prefer [a professional] who knows what you are going through, understands where you stand [in your process]. When you get a new [occupational healthcare professional], the question is to which extent they are aware of your situation. (..) I prefer a permanent [professional]” - PT 6 (male, 57, contracted employee, full sick leave)
4) INVOLVEMENT AND SUPPORT FOR FAMILY AND CARERS IN WORK-FOCUSED HEALTHCARE.
Support for family	“Besides, your partner also feels insecure, saying, ‘oh my husband has a cardiovascular disease’.” - PT 6 (male, 57, contracted employee, full sick leave)
5) CLEAR INFORMATION, COMMUNICATION AND SUPPORT FOR SELF-CARE REGARDING WORK PARTICIPATION.
Clear purpose and outcome of an encounter	“The letter stating that the disability benefit is granted is a reassuring statement at that time. However, there is a kind of calculation behind it which I still do not understand.” - PT 13 (male, 59, contracted employee, partly returned to work)
Information provision on the work-focused healthcare process	“[The rehabilitation professional] explained how the process works. At the moment you become ill, there is something about to happen that you do not know much about at that moment. (..) They guided me through it.” - PT 15 (male, 35, contracted employee, partly returned to work)
Information provision on the role and possibilities of the professionals	“During the application for the disability benefit, (..) I had the feeling that I had no idea how the process worked. (..) It would be better if you know the role of the professionals, what they know or do not know and which information they receive.” - PT 16 (male, 36, contracted employee, fully returned to work)
Informal contact at the workplace	“I have an employee at the office who can take over all my duties. He (this employee) knows exactly what I am working on. So there is a setup in place that when I am absent everything keeps going.” – PT 11 (male, 63, self-employed, fully returned to work)
6) INVOLVEMENT IN DECISIONS AND RESPECT FOR PREFERENCES REGARDING WORK PARTICIPATION.
Influence of personal factors	“When you are talking to someone who is 35 years old, (..) still at the beginning of their career, these questions [regarding reintegration] become much more important. There is a greater motivation to get back to work. I am just about to retire, that is a different story.” - PT 18 (male, 65, temporary agency worker, full sick leave)
Personal control during the process	“I was too sick to fight. (..) I had to tell [to the employer]: ‘you are just going to arrange [a suitable working position]. But at that point, I just was too tired.” - PT 3 (male, 57, temporary agency worker, full sick leave)
7) EMOTIONAL SUPPORT, EMPATHY AND RESPECT IN WORK-FOCUSED HEALTHCARE.
Empathy for the personal situation	“I really got the feeling that [the occupational healthcare professional] was not interested in my situation. And then I think to myself [during the encounter]: what am I doing here?” - PT 2 (male, 57, contracted employee, fully returned to work)
No contra productive pressure	“I have been given ample space [for recovery] within the process. (..) Professionals do not need to put pressure [on RTW], especially for cardiovascular patients.” - PT 6 (male, 57, contracted employee, full sick leave)
Emotional support from social environment	“My wife told me to call in sick. (..) [My wife] was highly involved in this process.” - PT 10 (male, 63, contracted employee, full sick leave)
8) ATTENTION TO PHYSICAL, PERSONAL AND ENVIRONMENTAL NEEDS REGARDING WORK PARTICIPATION.
Tailored work-focused support	“[The occupational healthcare professionals] have a number of checklists they need to go through. (..) they make a report of it, so they can demonstrate that it happened. (..) they just tick the checklists, and then it is considered sufficient.” - PT 16 (male, 36, contracted employee, fully returned to work)
Act in the interest of the patient	“I think [the occupational healthcare professionals] are compelled by the SSA to expedite your return to work as quickly as possible, so the disability benefit is minimized. It is not about you as an individual.” - PT 2 (male, 57, contracted employee, fully returned to work)
Sufficiently informed about the medical situation	“If [the occupational healthcare professional] ask you things which are on the first page of you medical file, so to speak, you start doubting if they are taking you seriously. You become suspicious if they are aware of your personal situation.” - PT 6 (male, 57, contracted employee, full sick leave)
Support to find an alternative work position	“Yes, [finding suitable work adjustments] went quickly and easily. (..) [my employer] easily adapted to [the situation].” - PT 9 (male, 61, contracted employee, full sick leave)

CVD: Cardiovascular disease, OP; occupational physician, RTW; Return to work, SSA; Dutch Social Security Institute: the Institute for Employee Benefit Schemes.

Picker.org. The Picker principles of person centred care. Available from: www.picker.org.

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