Table 2 Motivations accompanying the scores of importance (open questions) [Translated by the authors. Original source consisted of Dutch handwritten texts.]

1. Disease

#42

For prognosis of future functioning, [the] disease (nature plus^a severity) is [the] starting point for [the physician (]OP/IP^b[)]. […]

#32

Main point being whether or not the disease is progressive

#73

In the case vignette, it concerns a progressive disease; that certainly is determining for the prognosis. In general, there are also situations in which the patient’s coping is also an important factor, in addition to nature/severity of the disease

2. Treatment

#6

If there are several treatments available after the treatment that the client^c is currently receiving, then [there] may be a chance of improvement [of] work capacity

#27

[Treatment] [e]ffect; can be [an] indication for influencing progression. [Judgment on treatment] [a]lternatives; necessary for me for IVA^d. No alternatives left equals^e game over (end stage)

#26

In progressive diseases you are postponing [the] final state. In general: are there still valid treatment options?

#52

Treatment in this case vignette is aimed at treating symptoms. Not curative

3. Course

#4

Course, the past, tells something about the future

#27

Progressive disease, you want to know where [the patient] is on the downward line. The rest is not that important

4. Information and evidence

#15

C/ [Conclusion] of the treating neurologist (progressive complaints of illness)

#23

Evidence preponderates, [it] excludes bias in [the] treating physician

#19

Evidence [is] not necessary in most cases, because [they are] familiar, routine

#36

Especially with a substantial claim ([full disability pension/benefit,] IVA \* MERGEFORMATd): info, evidence

5. Patient-related considerations

#23

With a positive attitude [of the patient], the prognosis can turn out to be more favorable than the expectation [of the prognosis for that disease mentioned] in the evidence

#45

How the patient perceives^f [his or her] complaints and^g limitations plus \* MERGEFORMAT a advantages of being ill, coping determines the prognosis for recovery

#51

Given [the] age [of the] client \* MERGEFORMAT c, I would assign [a full disability pension/benefit,] IVA \* MERGEFORMAT d

#18

Age. To evaluate doesn’t equal^h “to take into account.”ⁱ Quality of life when client [is] continuing [to] work

#26

In general, these are rather predictive aspects for success in vocational rehabilitation. Not often part of the considerations [for] prognosis

#46

[It] [i]s derived from literature that patient’s opinion on duration of incapacity for work is an important prognostic factor. On the other hand, the perception of the patient can be influenced by the messages physicians provide. So, I see [the] perception of [the] patient as important and as influenceable

6. Physician-related considerations

#72

Own impression plusa assessment is also very important on [sic] the individual client, in addition to the info practitioner plusa available evidence

#32

I try to take these factors into account as little as possible

#50

[There] is [a] good chance that [the physician,] OP/IPb[,] takes “ethical” [sic] aspects into account; and certainly not if there is a less serious/threatening condition

#73

As [a physician performing disability evaluations,] IP^j[,] you have to deal with a legal framework. The judgment must be based on medical examination. The impression of the client can in my opinion^k not always be leading. Especially since there’s a financial interest. [This] [a]lso applies to eg [sic] empathy/compassion for the client. […]

#45

Physician bias plays a role too in assessing the prognosis

#42

A client should receive the same outcome with every [individual physician,] OP/IPb. Role interpretations OP.IP [sic] play no role then. I notice that I take patient’s age into account. Say [the patient is] 25 years old…

#24

Difficult to assign [a] gradation [to the] importance, because many factors are subconscious [“unconscious” in original]

#29

Is influence [of] your personal blind spot too

#27

I base prognosis in [sic] a theoretical framework. I try to be as objective as possible, but aware of my own experiences