RATIONALE & OBJECTIVE: Although patients with chronic kidney disease (CKD) are at risk for work disability and work loss, not all experience work disruption. We aimed to describe the experienced barriers to and facilitators of sustained employment among Dutch patients with CKD.
STUDY DESIGN: Qualitative study using semi-structured interviews.
SETTING & PARTICIPANTS: CKD Stage G3b-G5 patients (n = 27) from 4 nephrology outpatient clinics in the Netherlands.
ANALYTICAL APPROACH: Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health (ICF) framework.
RESULTS: Participants were 6 patients with CKD Stage G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified: 1) health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition); 2) personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit); and 3) environmental barriers related to nephrology care (waiting time, use of a hemodialysis catheter) and to work context (reorganization, temporary contract, working hours, physical demands). Environmental facilitators related to nephrology care (personalized dialysis, pre-emptive transplantation), to work context (large employer, social climate, mental job, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and to support at home. Occupational health services and social security could be either barriers or facilitators.
LIMITATIONS: The study sample of Dutch patients may limit the transferability of these findings to other countries.
CONCLUSIONS: The wide range of barriers and facilitators in all ICF components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational healthcare as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.