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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1120 — We Just Had to Deal with [Treatment] and Go to Work: The Impact of Work on Patients’ Abilities to Complete Hepatitis C Treatment

Fix GM, Center for Health Quality, Outcomes, and Economic Research (CHQOER); HIV/Hepatitis & eHealth QUERIs; Bolton RE, CHQOER; Drainoni ML, CHQOER; Boston University; Koppelman EA, CHQOER; Gifford AL, CHQOER; HIV/Hepatitis & eHealth QUERIs; Clark JA, CHQOER; HIV/Hepatitis QUERI;

Hepatitis C (HCV) treatment entails a lengthy, complex medication regimen with difficult side-effects, and subsequently low adherence rates. And yet, work-life issues lie largely outside the purview of treatment planning. Currently, little is known about the role work plays in patients’ treatment experiences. We sought to characterize patients’ perceptions of the relationships among work, HCV treatment, and treatment completion.

We conducted semi-structured, in-depth interviews with 60 patients from four VAMCs to elicit accounts of their HCV treatment experiences. The interview guide encompassed questions about diagnosis, treatment decision-making, managing side-effects, and medications. The multi-disciplinary research team met weekly, and iteratively developed the codebook through transcript review. Using an emergent, thematic strategy we identified major domains related to areas including disease and treatment experiences, key relationships, and the context within which treatment occurred. Sub-codes were analyzed comparatively, based on treatment completion status.

46 patients discussed work during their descriptions of HCV treatment. Work provided structure, normalcy, and an alternative focus to side-effects. Participants struggled with how to disclose their disease and treatment to coworkers. Those who either completed treatment or had to stop for clinical reasons talked about balancing work and treatment, often within supportive work places. Participants discussed structuring symptom management around work routines, such as coordinating injections with days off or ensuring they could sleep after their shift ended. They talked about accommodating employers, helpful coworkers, and flexible schedules. Others worked reduced hours, or delayed treatment initiation until retirement. In contrast, some patients who withdrew from treatment discussed work problems, including difficult bosses, and difficulties managing the physical or mental aspects of their positions, exacerbated by side-effects. Some spoke about particularly challenging episodes that led directly to terminating work or treatment.

Working while undergoing HCV treatment presented serious challenges to both job performance and treatment adherence. A supportive, flexible workplace eased the burden of treatment, while also providing motivation to withstand side-effects. Conversely, unsupportive, inflexible work places were incompatible with treatment.

Simultaneously managing work and treatment can be an important component of HCV self-management. Providers should include work-life and job performance when developing an HCV treatment plan.

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