Training and delivery of a novel fatigue intervention: a qualitative study of rheumatology health-care professionals’ experiences

Dures, E; Rooke, C; Hammond, A; Hewlett, S

Abstract

Objectives
Successful, non-pharmacological research interventions are challenging to implement in clinical practice. The aim of the study was to understand the experiences of rheumatology nurses and occupational therapists (tutors) delivering a novel fatigue intervention in a trial setting, and their views on requirements for clinical implementation. After training, tutors delivered courses of a manualized group cognitive-behavioural intervention to patients with RA in a seven-centre randomized controlled trial [Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT)], which demonstrated reduced fatigue impact at 2 years.
Methods Fourteen tutors participated in interviews, and eight tutors also participated in a focus group. Data were audio-recorded, transcribed and analysed using inductive thematic analysis. Results The following five main themes were identified: ‘exciting but daunting’ reflected the mixture of excitement and anxiety in intervention training and delivery; ‘skills practice and demonstrations were essential’ captured the value of learning and practising together, even though the process could be uncomfortable; ‘an individual approach to a standardized intervention’ showed how tutors negotiated adherence to the manual with delivery using their own words; ‘becoming a better practitioner’ described how participation enhanced tutors’ wider clinical practice; and ‘pragmatic and flexible’ highlighted practical adaptations to facilitate training and intervention roll out. Conclusion These insights inform strategies for clinical implementation of an evidence-based intervention that addresses a patient priority, with implications for other successful research interventions. Tutors believed that the skills acquired during RAFT enhanced their wider clinical practice, which highlights the benefits of upskilling members of clinical teams to provide self-management support to patients.

• Journal Article Type: Article
• Acceptance Date: Jul 1, 2019
• Online Publication Date: Jul 1, 2019
• Publication Date: Aug 27, 2019
• Deposit Date: Oct 10, 2019
• Publicly Available Date: Oct 10, 2019
• Journal: Rheumatology Advances in Practice
• Print ISSN: 2514-1775
• Electronic ISSN: 2514-1775
• Publisher: Oxford University Press
• Volume: 3
• Issue: 2
• DOI: https://doi.org/10.1093/rap/rkz032
• Publisher URL: https://doi.org/10.1093/rap/rkz032
• Related Public URLs: https://academic.oup.com/rheumap
• Additional Information: Access Information : The article and supplemental materials are Open Access; Projects : Reducing rheumatoid Arthritis Fatigue impact - clinical Teams using cognitive behavioural approaches (RAFT): randomised controlled trial with economic and qualitative evaluations