276 As a practitioner I feel enriched: rheumatology tutors’ experiences of delivering a manualised group cognitive-behavioural fatigue programme to patients with rheumatoid arthritis

Abstract

Background: Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT) is a seven-centre RCT of a manualised group cognitive-behavioural (CB) programme to reduce fatigue impact. After four days training plus a delivery observed by clinical supervisors, tutor pairs (rheumatology nurses and occupational therapists (OTs)) delivered the programme four times to patients with RA. Quality assurance observations confirmed tutors used CB approaches and RAFT results show the programme reduced patients’ fatigue impact at 26 weeks. The aim of the current study was to understand tutors’ experiences of RAFT training and delivery to inform future programme roll out. Methods: 14 RAFT tutors (nine nurses; five OTs) participated in one-to-one interviews, which were audio-recorded and transcribed. Data were analysed by ED, SH, and AH using inductive thematic analysis. Results: Four main themes were identified. Theme 1: It’s quite daunting - Delivering a complex programme that was “quite different to what any of us had done before” required time and effort (“I couldn’t really make sense of it without actually doing a lot of work around it”). Initially, training with clinical supervisors (experts) who are “so good at what they do” challenged tutors’ confidence (“the anxiety is are we going to deliver it the way they did?”). Theme 2: Most useful was actually getting to practice the sessions - Tutors valued watching clinical supervisors demonstrate programme sessions during training (“professionals who have shown us how to do it”) plus the opportunity to practice themselves (“role playing the sessions was really helpful”). Theme 3: Putting it in a way that was still true to the message - the RAFT manual was “very valuable” and “it had to be adhered to”; however, tutors wrote individual crib notes (“our own manual in our own words”) to consolidate information, deepen understanding, and gain confidence. The process was supported by “positive and constructive criticism” in the observed delivery (“the supervisor kept putting us back on track”). Theme 4: As a practitioner I feel enriched - CB skills acquired during RAFT impacted tutors' wider work (“making a massive difference to my clinical practice”), and enhanced the self-management support they offered patients, including “the particular ability to draw things out from people” and “learning when to listen and stand back and try and get the patients to find the answers”. Conclusion: Initially, RAFT training and delivery were a challenge for tutors because the CB approach was a new way of working. Individually adapting RAFT manual wording plus feedback from supervisors increased tutors’ confidence. Tutors believed the CB skills acquired during RAFT enhanced their wider clinical practice and the self-management support they offered patients. Future training should include RAFT session demonstrations and skills practice for tutors, with feedback from clinical supervisors.