Probability of causation for multi-causal occupational disease compensation: A scoping review of methods and alternatives

Abstract Background: Diseases of multi-factorial etiology pose challenges for attributing causation to specific exposures. The probability of causation (PoC) is commonly used to determine whether a worker's cancer is more likely than not due to occupational exposure, but has limitations (e.g., not accounting for acceleration of cancer occurrence).

Objectives

To describe PoC methods applied for occupational lung cancer compensation (PoC review), and improvements or alternatives for compensating workers with multi-causal occupational diseases (Alternatives review). Sources of evidence: PubMed and Embase were queried for both reviews (May 2025). The PoC review additionally searched OpenAlex with citation snowballing (n=1,697 records); CINAHL was additionally queried for the Alternatives review (n=329). No language restrictions were applied. Registered protocol: https://osf.io/9evsy. Charting methods: Titles and abstracts were screened using ASReview. Data extracted included chemical/physical agent, PoC thresholds, uncertainty sources, and methodological improvements or alternatives for compensation.