title: Rheumatology clinicians' experiences of brief training and implementation of skills to support patient self-management.
abstract: BACKGROUND
  Self-management of arthritis requires informed, activated patients to manage its physical and psychosocial consequences. Patient activation and self-management can be enhanced through the use of cognitive-behavioural approaches, which have a strong evidence base and provide insight into the variation in outcome of patients with ostensibly the same degree of disease activity. However, training for rheumatology health professionals in theory and skills underpinning the facilitation of self-management is not widely available. To develop such training, this study explored rheumatology clinicians' experiences of a variety of brief skills training courses to understand which aspects were helpful or unhelpful, and to identify the barriers and facilitators of applying the skills in clinical practice.
  
  
  METHODS
  16 clinicians who had previously attended communication and self-management skills training participated in semi-structured interviews: 3 physicians, 3 physiotherapists, 4 nurses, 6 occupational therapists. Transcripts were analysed (ED) using a hybrid inductive and deductive thematic approach, with a subset independently analysed (SH, RG-H, RJ).
  
  
  RESULTS
  3 overarching themes captured views about training undertaken and subsequent use of approaches to facilitate self-management. In 'putting theory into practice', clinicians felt that generic training was not as relevant as rheumatology-specific training. They wanted a balance between theory and skills practice, and identified the importance of access to ongoing support. In 'challenging professional identity', models of care and working cultures influenced learning and implementation. Training often challenged a tendency to problem-solve on behalf of patients and broadened clinicians' remit from a primary focus on physical symptoms to the mind and body interaction. In 'enhanced practice', clinicians viewed consultations as enhanced after training. Focus had shifted from clinicians' agendas to those of patients, and clinicians reported eliciting patients' priorities and the use of theoretically-driven strategies such as goal-setting.
  
  
  CONCLUSIONS
  To varying extents, clinicians were able to learn and implement new approaches to support patient self-management after brief training. They believed that cognitive behavioural and communication skills to facilitate self-management enhanced their practice. To optimise self-management support in routine care brief, skills-based, rheumatology-specific training needs to be developed, alongside ongoing clinical supervision. Further research should examine patients' perspectives of care based on these approaches.
authors.affiliation: University of the West of England, Bristol, UK. emma2.dures@uwe.ac.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Dures
authors.forename: Sarah
authors.initials: S
authors.lastname: Hewlett
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ambler
authors.forename: Remona
authors.initials: R
authors.lastname: Jenkins
authors.forename: Joyce
authors.initials: J
authors.lastname: Clarke
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
mesh_terms: D000328:Adult; D001168:Arthritis / Q000523:psychology / Q000628:therapy*; D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D004496:Education, Continuing; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009788:Occupational Therapy; D010348:Patient Care Team; D010358:Patient Participation; D059825:Physical Therapists / Q000193:education*; D010820:Physicians; D011340:Problem Solving; D011369:Professional-Patient Relations; D012219:Rheumatology / Q000193:education*; D012648:Self Care; D020377:Self Efficacy