Acceptability of a brief fatigue intervention for inflammatory arthritis: a qualitative process evaluation

Abstract

Objectives We developed a brief cognitive-behavioural, one-to-one intervention to reduce fatigue impact for patients with inflammatory arthritis. This qualitative process evaluation explored intervention acceptability and potential refinements from the perspective of (i) patients who attended sessions and (ii) rheumatology health professionals (RHPs) who delivered the intervention. Methods Interviews were conducted with patients and RHPs from five NHS sites. Data were analysed using inductive thematic analysis. Results Twenty-two patients and eleven RHPs participated. Patient themes Collaborative, non-judgemental consultations: patients valued having space to reflect, where their fatigue was validated. Relevant content, but not ground-breaking: patients appreciated the opportunity to tailor content to individual priorities. Daily diaries were useful to visualise fatigue. Self-awareness: patients reported increased acceptance, sense of control, and confidence to manage fatigue. Degrees of openness to change: sessions prompted patients to engage in behaviour change. For some, complicated lives made it difficult to plan for change. RHP themes Engagement with intervention: RHPs liked training face-to-face, and sessions were more enjoyable with experience of delivery. Research versuss clinical practice: RHPs expressed concern about fitting sessions into NHS clinic appointments. It was difficult to offer follow-up sessions within two-weeks. Collaborating with patients: RHPs reported that patients engaged with the tools and strategies. Some RHPs followed the manual in a linear way, others used it flexibly. Conclusions There is potential for this brief fatigue intervention to benefit patients. Future research will focus on flexibility to fit with local services and creating educational resources to use in a range of contexts. Lay summary What does this mean for patients? This purpose of this study was to find out what patients and health professionals thought about taking part in fatigue management sessions for people with inflammatory arthritis. We discussed the sessions with 22 patients who attended sessions, and eight health professionals who were trained in and delivered the sessions. Patients told us that they liked having an opportunity to talk about their fatigue. Although the information was not always new, they liked the resources, including the daily diaries. Sessions made them think about things in their day-to-day lives that might be making their fatigue worse. For some, it gave them ideas about things to change or do differently. Health professionals liked training with other health professionals and felt more confident about the fatigue sessions with practise. Some were using the fatigue information and resources in their usual consultations. Sometimes it was difficult to make sure everyone had enough time, and to fit in all the appointments within the recommended two-week time frame. The results show that patients value the opportunity to address their fatigue with a health professional, but also the challenges of providing these sessions in clinical practice.

2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

“…This awareness should facilitate discussions with people who have I-RMDs about which specific factors might be pertinent for them as individuals. People with I-RMDs have reported that being asked about their fatigue can be validating and make them feel less isolated; for some, it can be the first step to self-management 38 39…”