title: The provision of workplace accommodations following cancer: survivor, provider, and employer perspectives.
abstract: With improvements in screening, diagnosis, and treatment, the number of persons surviving cancer and staying at or returning to work is increasing. While workplace accommodations optimize workers' abilities to participate in the workforce, there has been little in-depth investigation of the types of accommodations reported to have been provided to cancer survivors and the processes relevant to ensuring their successful implementation.
  
  
  
  We employed an exploratory qualitative method and conducted 40 semi-structured interviews with three groups: (i) cancers survivors (n = 16), (ii) health/vocational service providers (n = 16), and (iii) employer representatives (n = 8) to explore return to work and accommodation processes, successes, and challenges. An inductive thematic analysis approach was used to analyze the data.
  
  
  
  Four types of accommodations were recommended: (1) graduated return to work plans and flexible scheduling, (2) modification of work duties and performance expectations, (3) retraining and supports at the workplace, and (4) modification of the physical work environment and/or the provision of adaptive aids/technologies. Processes relevant to ensuring effective accommodations included: (1) developing knowledge about accommodations, (2) employer's ability to accommodate, (3) negotiating reasonable accommodations, (4) customizing accommodations, and (5) implementing and monitoring accommodation plans. Accommodation challenges included: (1) survivors' fears requesting accommodations, (2) developing clear and specific accommodations, (3) difficult to accommodate jobs, and (4) workplace challenges, including strained pre-cancer workplace relationships, insufficient/inflexible workplace policies, employer concerns regarding productivity and precedent setting, and limited modified duties.
  
  
  
  Accommodations need to be customized and clearly linked to survivors' specific job demands, work context, and available workplace supports. Survivors need to feel comfortable disclosing the need for accommodations. Ongoing communication and monitoring are required to ensure accommodations are implemented and changes made to the return to work plan as required.
  
  
  
  The provision of appropriate workplace accommodations can enhance survivors' abilities to stay or return to work.
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada. mary.kita@utoronto.ca.|Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. mary.kita@utoronto.ca.|Institute of Work & Health, Toronto, ON, Canada. mary.kita@utoronto.ca.|Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. mary.kita@utoronto.ca.
authors.forename: Mary
authors.initials: M
authors.lastname: Stergiou-Kita
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto, ON, Canada.|Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre University Health Network, Toronto, ON, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pritlove
authors.affiliation: Institute of Work & Health, Toronto, ON, Canada.|School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Dwayne
authors.initials: D
authors.lastname: van Eerd
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Department of Medicine, Faculty of Medicine, Toronto, ON, Canada.|Department of Occupational and Environmental Health and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Linn D
authors.initials: LD
authors.lastname: Holness
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Kirsh
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Duncan
authors.affiliation: Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre University Health Network, Toronto, ON, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jones
mesh_terms: D000328:Adult; D003142:Communication; D004651:Employment / Q000458:organization & administration / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation*; D009786:Occupational Health Services / Q000458:organization & administration; D010465:Perception; D062707:Return to Work / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D017132:Workplace / Q000458:organization & administration* / Q000523:psychology*
keywords: Cancer; Cancer survivors; Employment supports; Return to work; Workplace accommodations