721 Assessment of prognosis by physicians working in the field of disability evaluation: a qualitative study

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Abstract

Introduction

Assessment of prognosis including improvement of work functioning is challenging and research on this topic is lacking. To make this process more explicit, the following research question was formulated: Which aspects and considerations, difficulties, needs and potential solutions, affecting the prognosis assessment by physicians, working in the field of disability evaluation, can be identified?

Methods

In-depth, semi-structured individual interviews were conducted with 20 physicians working in the field of disability evaluation at the Dutch Social Security Institute (UWV). Verbatim transcripts were independently analysed by two researchers until data saturation was achieved and significant themes emerged.

Results

Aspects and considerations affecting the prognosis assessment consisted of medical themes including nature and severity of disease, the role of treatment, course of the disease, and medical evidence. In addition, patient-related and physician-related aspects were distinguished. Patient-related aspects as the patients’ work perspectives, coping or recovery behaviour and physician-related aspects as awareness of the physicians’ own role and reflection on empathy for clients and ethical considerations were deemed to be important. Difficulties described by physicians were assessment of complex diseases, applying prognostic evidence to the individual and lack of time when seeking for prognostic evidence. Needs and solutions formulated by physicians, were continuous education, better collaboration with medical specialists and/or labour experts and the use of prognostic tools like checklists, apps or internet applications to incorporate evidence on prognosis.

Discussion

Physicians identified several medical and patient-related aspects, elucidating the process of prognosis assessment. A variety of difficulties were reported and physicians expressed their needs for further support. Future research could focus on development, efficacy and feasibility of training, prognostic tools, guidelines, collaboration with labour experts or information exchange with medical doctors in different specialties.

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