"Gout was the boss": a qualitative interview study of impact of gout in work.
Cesar Diaz-Torne, Maria A. Pou, Chiara Gasteiger, Anne Horne, Nicola Dalbeth
Affiliation(s):
University of Auckland
Background: gout is the most common form of inflammatory arthritis, and causes pain,
inflammation and decreases quality of life. Previous qualitative studies have analysed the
impact of gout on various domains, but there have been no previous studies designed to
examine its impact on employment.
Objective: to identify and describe patients’ opinions and experiences of the impact of gout on employment.
Methodology: qualitative study using in-depth, semi-structured face-to-face interviews of
persons who had experienced a gout flare during their working years. The study aimed for
diverse demographics, job types and gout characteristics. The interviews were guided by key questions covering impact in employment, job changes, disclosure and co-worker reactions. Final sample size was determined when the richness, depth and relevance of the information obtained was reached and when additional themes were no longer identified. The interviews were collected, recorded and transcribed in full. Reflective thematic analysis was used for data analysis. Verbatim transcripts of audio recordings were subjected to thematic analysis using NVivo software to facilitate coding, sorting and data retrieval.
Results: Eighteen participants were included. Demographic, clinical and work characteristics are shown in table 1. The key themes that emerged from the interviews were grouped into six main categories:
1. Gout Factors: Participants highlighted the intensity of pain, the presence of tophi, and the joints affected as critical factors to understand how gout impacts employment. Severe flares often made work nearly impossible, while mild flares were considered just an inconvenience. The location of the affected joints also influenced patients’ ability to work.
2. Employment factors: Physical requirements and workplace flexibility were significant issues. Jobs with high physical requirements were particularly challenging. Lack of workplace flexibility, including the ability to work remotely, change meeting dates, or adapt tasks, had a significant impact on the patients’ ability to continue working.
3. Physical Experience: Participants described a wide range of physical experiences, from working with discomfort to being unable to work. Ability to work and concentration were affected by the severity of the flare. Additionally, difficulty in commuting to the workplace was a significant factor.
4. Psychological Experience: Patients reported feelings of responsibility, embarrassment, guilt and depression. Feeling responsible for missed work, reduced efficiency, or the need for help was a common theme. Some felt embarrassed about having gout and tried to hide it, especially younger patients and women. Others experienced guilt, particularly if they believed their disease was self-inflicted. Some patients even reported feeling depressed due to the limitations imposed by gout.
5. Social Experience: The effects of gout extended beyond the direct impact of the disease at work and affected other spheres. This included concerns about disclosing the condition at work, the prioritization of work over other life roles and a negative financial impact.
6. Positive Impact of Effective Gout Management: Proper gout management was identified as crucial to improve their patient experiences. Understanding the disease, managing acute gout attacks with anti-inflammatories, and adhering to urate-lowering therapy were described as key elements to prevent flares, reduce pain intensity, and maintain the ability to work.
Conclusions: This study sheds light on the multifaceted impact of gout on work and employment, emphasizing the importance of both disease management and workplace adaptations for gout patients.