Implementation of the PsoWell™ Model for the Management of People with Complex Psoriasis

Abstract

The Psoriasis and Well-being (PsoWell)™ training programme, incorporating motivational interviewing, improves clinicians’ knowledge and skills to manage complex psoriasis, including behaviour change. The aims of this study were to deliver the PsoWell™ training programme to dermatology specialists, and to evaluate the acceptability and feasibility of implementing the PsoWell™ model across dermatology services. Framework analysis of 19 qualitative semi-structured interviews was performed, following delivery of nine, 1-day PsoWell™ training days involving 119 participants. Two themes were identified: “Perceptions and Priorities” and “Awareness”, sub-divided into: “Awareness Not Competence” and “Increasing Awareness”. The PsoWell™ model was found to be acceptable and feasible to implement across dermatology settings. Participants were more skilled and motivated to address psychological issues, including behaviour change, but wanted further training to ensure competency. The trainees claimed that scepticism among some colleagues regarding whole-patient management might prevent uptake. Data showing the impact on health outcomes are needed and might overcome scepticism. Remote consultation could adopt the PsoWell™ approach.

How do dermatologists’ personal models inform a patient‐centred approach to management: a qualitative study using the example of prescribing a new treatment (Apremilast)*

“…Improving clinicians’ awareness of how their personal models impact on psoriasis management and their relationships with patients may improve patient outcomes, such as increased adherence. PsoWell™ (psoriasis and wellbeing) is an evidence‐based training programme that specifically aims to teach health professionals who are involved in psoriasis management motivational interviewing 30 techniques to promote better patient self‐management and increase shared decision making within a consultation 11,31 . Attending the PsoWell™ training programme could help clinicians to become more aware of their personal models of psoriasis and improve their consultation skills.…”

“…PsoWell TM (psoriasis and wellbeing) is an evidencebased training programme that specifically aims to teach health professionals who are involved in psoriasis management motivational interviewing 30 techniques to promote better patient self-management and increase shared decision making within a consultation. 11,31 Attending the PsoWell TM training programme could help clinicians to become more aware of their personal models of psoriasis and improve their consultation skills. Our findings also suggest that as female clinicians are more likely to involve patients in treatment decisions, the PsoWell TM training programme may be an ideal professional development activity for male clinicians, in particular, who are interested in facilitating shared decision making in their practice.…”

“…Research suggests that whilst some clinicians offer patients generic lifestyle advice on biologic treatments via checklists 7 , many clinicians do not use opportunities to discuss health behaviour change during consultations 7 8 and report needing training to provide basic psychological support including health behaviour change [7][8][9][10][11] . Clinicians not acknowledging the wider impact of psoriasis on the patients' life can lead to patients feeling dissatisfied with their care [12][13][14] .…”

“…6 Research suggests that while some clinicians offer patients generic lifestyle advice on biologic treatments via checklists, 7 many clinicians do not use opportunities to discuss health behaviour change during consultations 7,8 and report needing training to provide basic psychological support including health behaviour change. [7][8][9][10][11] Clinicians not acknowledging the wider impact of psoriasis on the patients' life can lead to patients feeling dissatisfied with their care. [12][13][14] Shared decision making is a patient-centric approach whereby clinicians provide patients with tailored information about their condition and treatment options in order to inform and empower patients to make joint decisions about their health.…”

Psychodermatology and health psychology care in dermatology

“…Hewitt and colleagues (2021) examined the effects of a motivational interview and one-day training for professionals in the United Kingdom to help change behavior in psoriasis patients. Representatives of several professions, dermatologists, psychologists, and nurses also participated in the training, and it was reported that this increased their skills, confidence, and motivation to support their patients' behavioral changes (Hewitt et al, 2021). Psychodermatology seminars were held in the city of Kiel, Germany between 2018 and 2020 as part of an educational program for medical students from the University Department of Dermatology, during which students had the opportunity to learn about skin stress and the biopsychosocial disease model (Wittbecker et al, 2021).…”