By Julie Bowring, Research Associate, Institute for Work & Health

Arthritis affects 4.3 million Canadians, 60% of whom are under the age of 65. Not surprisingly, the health condition has a big impact on the ability of people with arthritis to find work and keep working throughout their lives. Yet, we know little about how people with arthritis balance their work responsibilities with the management of their health condition at different stages of their lives.

As part of a study conducted through the federally funded Canadian Disability Participation Project (CDPP), Dr. Arif Jetha, an Associate Scientist at the Institute for Work & Health (IWH) in Toronto, aimed to learn more. Through interviews and focus groups, he talked to 45 young, middle-aged and older adults living with arthritis to learn how their experiences of working with arthritis differed. He heard from participants that unique milestones shape employment experiences at different times of life.

For young adults with arthritis, the transition from school to work was a significant source of stress. They devoted a great deal of time and energy to finding full-time employment, even if that meant sacrificing involvement in other areas of life. Middle-aged people with arthritis were handling the most responsibility in their careers while juggling roles outside of work, including parenting, marriage and leisure. Older adults with arthritis were considering the transition from work to retirement, weighing multiple factors such as health, financial and personal interests.

Dr. Jetha also examined the different types of job accommodations that were needed and used by participants at different stages of their lives. He learned that, regardless of age or career stage, adults with arthritis needed flexible scheduling, extended drug benefits, accessibility within the workplace, opportunities to modify work, and support from supervisors and co-workers.

On the other hand, the availability and use of job accommodations tended to differ at different career stages. Being at the early career stage, young adults with arthritis were often working in part-time or non-permanent jobs where job accommodations were not always available. Because arthritis is often seen as only affecting older people, young adults found it particularly difficult to disclose their arthritis and request accommodations within the workplace.

In comparison, middle-aged and older participants were more likely to access the job accommodations they needed to sustain employment and receive support. This was especially true for those who had been with the same organization for a long period of time and had built up a level of trust with their colleagues and supervisors that enabled them to gain access to the accommodations that were most needed.

According to Dr. Jetha, the results of this study clearly indicate a need for greater organizational awareness about the impact of arthritis on employees of all ages. The experiences of working with arthritis differ across the stages of life, and require unique workplace strategies to encourage access to the job accommodations and support that are most needed.

To learn more about the study or participate in future research, please contact the study author.

Choosing Wisely: What you Need to Know

By: Janet Gunderson

In 2014, Choosing Wisely Canada (CWC) was started in partnership with the Canadian Medical Association inspired by a similar initiative launched in the United Stated in 2012. The Choosing Wisely campaign aims to help physicians and patients engage in a dialogue about unnecessary tests, treatments, medications and procedures.  This is not a program that is just designed to save cost to our medical system.  Unneeded tests can also lead to harms like false positives, patient anxiety, overmedication and inconvenience.

Over forty-five different medical specialties including General Practitioners were asked to come up with five tests or procedures that could be used more effectively than they had been. Each specialized area came up with a recommendation for their list of five.  These were suggestions – not rules – so that if a doctor felt a particular patient needed the test, they could still request it.  This program was designed to help practitioners make more effective choices to ensure a high quality of care.  Often these recommendations would lead to the development of patient-friendly materials in a plain language that would help explain when the test was and was not needed.  Sometimes these recommendations led to patient decision aids which are tools that help people become involved in decision making. The decision aid helps the patient make the decision that needs to be made by providing information about the options and outcomes, and by clarifying personal values.

Don’t hesitate to ask your doctor if a test is really necessary as this can lead to better understanding of the need for the test and any risks involved. You may also wish to ask what would happen “if I do nothing”.  A good example of this might be used in the case of getting an x-ray for a low back problem.  A physician should be prepared to explain why they are sending the patient for certain tests and if there are any risks involved.  Good communication between you and your doctor can go a long way in getting the right health care suited to your needs.

In February, I was pleased to represent CAPA at the second annual Canadian Choosing Wisely Conference in Calgary.  There were 350 participants the first day and there were more people that would have liked to attend. We were treated to two keynote speakers: Dr. Angela Caulfield gave an interesting presentation on “Helping Patients Make Wise Choices” and Dr. Tim Caulfield spoke on “The Genetic Revolution, Personalizes/Precision Medicine and Choosing Wisely”.  I also had the opportunity to participate in several breakout sessions and it proved to be an interesting and educational day. A workshop was held on the second day, it included a plenary session.  The workshop consisted of forty-five people who were doctors, patients, pharmacists and others. We worked through several small group activities and priority setting exercises.  People were very interested in continuing involvement with Choosing Wisely Canada. It was a very interesting workshop.

CAPA has three videos on our website about the Choosing Wisely initiative.  To check out Choosing Wisely recommendations relating to arthritis, visit this link on the CAPA website.