Self-management requires informed, activated patients to manage the physical and psychosocial consequences of arthritis, and to make lifestyle changes. The process of self-management focuses on developing skills such as problem solving, decision making, and appropriate use of healthcare resources. Taking an active role in their own care is rarely a choice that patients can enact alone, and is highly influenced by the dynamic created in the way care is provided. Rheumatology clinicians are well placed to utilise a range of basic psychological skills and techniques to facilitate a collaborative interaction and support self-management. These include: key questions at the start of the consultation to prompt patients to identify their priorities; formulation to unpick the relationship between thoughts, feelings, symptoms and behaviours, and how they are driving symptoms; and double-sided reflection and listing pros and cons of a behaviour.
Qualitative research conducted with rheumatology clinicians who have undertaken brief skills training, identified barriers and facilitators of using psychological approaches in routine clinical care to facilitate self-management. Barriers included: a lack of time in clinic; the difficulties of changing the existing pattern and focus of interaction; and concerns about exploring social and emotional aspects of living with arthritis. Facilitators included: training that balanced theory with time to practice skills and receive feedback; access to clinical supervision to gain confidence and develop more advanced techniques; and the perception that patients gained a greater sense of control and were better able to take responsibility for their treatment, as a consequence of a more collaborative consultation.
Disclosure of Interest None Declared