title: Factors influencing the occupational trajectory of patients with systemic sclerosis: a qualitative study.
abstract: OBJECTIVE
  To describe, from the patient's point of view, the factors influencing the occupational trajectory of patients with systemic sclerosis (SSc).
  
  
  METHODS
  This was a qualitative study designed using grounded theory with constant comparison. Data were collected through semi-structured interviews with 14 patients who fulfilled the American College of Rheumatology or Leroy-Medsger criteria for SSc.
  
  
  RESULTS
  Based on our interviews, we found that the occupational trajectory of patients with SSc is influenced by the continuous interplay between four groups of factors. The first group concerns the values patients attribute to work, including identity, normality, financial value, social contact, and structure. The meaning of these values and how they relate to each other underlies the desire to work. A second group of factors is those influencing the balance between daily life, work participation, and medical condition (e.g. job content, flexibility in organising work, and the willingness to ask for accommodations at work). The occupational trajectory is also influenced by external factors, including availability of support, know-ledge of the disease, pressure to work, contact with medical professionals, and existing regulations and the patient's knowledge about them. Finally, the occupational trajectory is influenced by personal factors, including socio-demographics, psychological assets, and disease- and work-related personal factors.
  
  
  CONCLUSIONS
  The decisions patients with SSc take concerning work depend on an interplay between many factors and, especially, on the patients' personal interpretation of these factors. These need to be taken into account when helping patients with SSc determine their occupational trajectory.
authors: Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University; and Department of Rheumatology, Ghent University Hospital, Belgium. saskia.decuman@ugent.be.
authors: Saskia
authors: S
authors: Decuman
authors: Department of Rheumatology, Ghent University Hospital, Belgium.
authors: Vanessa
authors: V
authors: Smith
authors: Faculty of Medicine and Health Sciences, Department of Public Health - Nursing Science, Ghent University, Belgium.
authors: Maria
authors: M
authors: Grypdonck
authors: Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University; and Department of Rheumatology, Ghent University Hospital, Belgium.
authors: Filip
authors: F
authors: De Keyser
authors: Faculty of Medicine and Health Sciences, Department of Public Health - Nursing Science, Ghent University, Belgium.
authors: Sofie
authors: S
authors: Verhaeghe
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002755:Choice Behavior; D017281:Cost of Illness; D004651:Employment; D005260:Female; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D007182:Income; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D010361:Patients / Q000523:psychology*; D011379:Prognosis; D036301:Qualitative Research; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D012919:Social Behavior; D012933:Social Identification