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Additional file 1. Example questions from the semi-structured interview guides per perspective and tool.

Additional file 2. Results of the interviews from an educational perspective and professionals perspective per developed tool.

Decisions to (de-)implement occupational safety and health (OSH) interventions are not always supported by the best available scientific evidence. The aim of this thesis is to investigate how researchers can support OSH decision makers in using the best available evidence when (de-)implementing OSH interventions. In the first part of the thesis, we looked at the quality of evidence from research studies that can inform policy makers’ and other stakeholders’ decisions. In the second part of the thesis, we analysed how OSH decision makers can make evidence-informed decisions from both a population and individual perspective. The thesis consists of five studies: two Cochrane systematic reviews, an analysis of the reporting quality of randomized controlled trials (RCTs) in OSH, the implementation of the evidence-to-decision framework for policy decisions regarding (de-)implementing return to work coordination interventions, and the development and feasibility study of a decision aid for healthcare workers on the use of double gloves to prevent needle-stick injuries. We found moderate to very low-quality evidence from OSH intervention studies. Most trials do not fulfil the Consolidated Standards of Reporting Trials (CONSORT) which negatively impacts the risk of bias assessments, and thus the quality of the evidence in OSH. The evidence-to-decision framework for policy makers and a decision-aid for workers enabled a systematic and transparent approach to decision making that is informed by the best available evidence for all relevant decision-making criteria, such as effectiveness, costs, and personal values.

The number of people in the working age with a chronic disease is rising. Occupational physicians and insurance physicians are occupational health professionals (OHPs) with a key role to increase work participation of people with a chronic disease by intervening on factors that can limit work participation. Important factors in this are cognitions and perceptions of workers, such as motivation or expectations regarding return to work. The main objective of this thesis is to gain more knowledge on how OHPs can involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. Part I of this thesis describes two literature reviews, a survey study among OHPs and a focus group study among workers in which knowledge was acquired regarding ten cognitions and perceptions associated with work participation, how OHPs can obtain information about these factors and how they can intervene on these factors when necessary. With the outcome of these studies a training program on cognitions and perceptions for OHPs was developed and evaluated, which is described in Part II of this thesis. In addition, the effects of the training were studied in a randomized controlled trial. Participation in the training program increased the ability of OHPs to identify cognitions and perceptions of workers and to recommend evidence-based interventions. OHPs were very satisfied about the training program. They thought it was useful for practice and were more aware of cognitions and perceptions during consultations after following the training. However, lack of time was perceived as a barrier when implementing the learned skills into practice. The thesis concludes with recommendations for OHPs to identify cognitions and perceptions, to discuss cognitions and perceptions during consultations, and to advice about interventions to change these factors. Participation of OHPs in the new developed training program is recommended.

Work is one of the main pillars of cancer survivorship, but still approximately 40% of cancer survivors are not able to return to work within a year of diagnosis. Employers play a vital role in guiding employed cancer survivors during their sickness absence and return to work (RTW), but regard the guidance of cancer survivors as difficult to manage. The aim of this thesis was to develop and pilot test an intervention (called the MiLES intervention) targeting the employer that enhances the successful RTW of cancer survivors. The thesis identified the most important employer actions and the support needs of employers in guiding employed cancer survivors during their sickness absence and RTW. On this basis, the MiLES intervention was developed, which is a web-based intervention with succinct, tailored tips and information, communication videos and conversation checklists. Employers perceived the intervention to be a useful tool that well suits their daily practice. However, whether the intervention is actually effective in enhancing the successful RTW of cancer survivors cannot be concluded on the basis of the studies presented in the thesis. The thesis also revealed that, according to cancer survivors, a successful RTW comprises more than just returning to the workplace. Therefore, an outcome measure that incorporates cancer survivors’ perspectives on what is perceived as successful RTW was developed: the Successful Return-To-Work Questionnaire for Cancer Survivors (I-RTW_CS). The I-RTW_CS enables an in-depth evaluation of a cancer survivor’s RTW, taking into account individual perspectives on a successful RTW. The thesis concluded that employers are an important link in the RTW process of cancer survivors, but need to be supported to fulfill this role. The MiLES intervention provides employers a promising tool to enhance successful RTW of cancer survivors.

Almost half of the patients with cancer are of working age and their survival rate is steadily increasing. Due to the increasing retirement age, the number of cancer survivors in the working population will rise. Although (return-to) work-related problems are experienced even at diagnosis, there are no support interventions yet at that particular moment. Work-related problems can vary in severity and therefore it is of interest to tailor this kind of support to the patient. The focus of this thesis was to develop and evaluate a tailored work-related support intervention in the clinical setting for patients diagnosed with curative gastro-intestinal (GI) cancer. The development of the intervention was based on literature and expert consultations; it included three types of psychosocial work-related support, based on the severity of the work-related problems. The healthcare professionals assigned to provide this supportive care were tailored as well including an oncological nurse, an oncological occupational physician or a multidisciplinary team. A multicenter Randomized Controlled Trial (RCT) was performed to evaluate this tailored work-related support intervention in clinical practice. In total, 88 patients were randomly assigned. The primary outcome ‘days until full-time or partial RTW’ showed a difference of 43 days between the intervention – and control group. The intervention was generally perceived as positive and feasible. Notwithstanding, along with the positive experiences, there were some barriers as well which need to be tackled in future. The process evaluation offers scope for improvement in future research.

Cancer survivors can experience difficulties in return-to-work or work continuation. Current outcomes in research describing the working life of cancer survivors offer little insight into cancer survivors’ experiences and perceptions of work, that is to say, the Quality of Working Life (QWL) of cancer survivors. In order to improve cancer survivors’ return-to-work or work continuation, it is important to assess and evaluate the QWL of cancer survivors, which is the aim of this thesis. First, a measurement instrument was developed. Second, its psychometric properties (factorial structure, internal consistency, construct validity, and reproducibility) were determined. Third, QWL of cancer survivors was described and its associations with health-and work related variables were assessed. The research resulted in a 23-item self-administered questionnaire that measures QWL of cancer survivors, named the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS). Five factors in the QWLQ-CS were identified: 1) Meaning of work, 2) Perception of the work situation, 3) Atmosphere in the work environment, 4) Understanding and recognition in the organisation, and 5) Problems due to the health situation. The internal consistency of the QWLQ-CS and its subscales were good, and the QWLQ-CS showed adequate construct validity and reproducibility for use at group level. The QWL mean score of cancer survivors was 75 (range 0-100, standard deviation: 12). Health- (e.g. type of treatment) and work related (e.g. physically demanding work) variables were associated with QWL in cancer survivors. The QWLQ-CS is a valid and reliable measurement instrument that can be used in research and practice.

Sietske Tamminga onderzocht hoe de arbeidsparticipatie van mensen met kanker kan worden geoptimaliseerd. Daartoe ontwikkelde zij een interventie die is getoetst op toepasbaarheid en effectiviteit. De interventie blijkt goed uitvoerbaar in de psychosociale oncologische zorg. Patiënten en uitvoerders zijn tevreden. Bijna de helft van het aantal patiënten had na twaalf maanden volledig het werk hervat. Tamminga’s onderzoek bevestigt het belang van werk voor mensen met kanker. Verdere ontwikkeling van interventies die kankerpatiënten ondersteunen bij werkhervatting is noodzakelijk.