Developing and testing a brief, opportunistic intervention, to be delivered by dermatology clinicians, to support weight-management for people living with psoriasis

Background A million people in the UK live with psoriasis, a chronic, inflammatory skin disease with a profoundly-negative impact on quality of life. Obesity increases susceptibility to psoriasis, and worsens its severity, including psoriatic arthritis. Obesity also reduces the effectiveness of psoriasis medications. Psoriasis is also associated with other weight-related comorbidities including type 2 diabetes and cardiovascular disease. My systematic review shows moderate weight-loss can lead to meaningful reductions in psoriasis severity. NICE recommends clinicians offer weight-management advice to people with psoriasis, but this rarely happens. Clinicians cite lack of time or knowledge, and concerns about upsetting patients. Formative interviews with patients showed they were unaware of the link between psoriasis and weight. They were keen to hear about dietary changes to improve their skin, but were not confident that doctors knew about this, so were unlikely to raise the topic. The Brief Intervention for Weight Loss (BWeL) Trial in primary care, showed that a Aim Co-develop and test a brief, opportunistic intervention, to be delivered by dermatology clinicians in routine outpatient clinics, to support weight-management for people living with psoriasis. If feasible, this will provide the necessary evidence to plan a full trial, to test whether the intervention can improve psoriasis outcomes. Methods WP1: Qualitative interview study Semi-structured interviews with 10-20 patients and 10-20 healthcare professionals, exploring knowledge, experience and opinions of weight-management approaches to treat psoriasis. Thematic analysis. WP2: Intervention co-development Co-develop a brief, opportunistic intervention to be delivered by clinicians in dermatology outpatient clinics, to educate and motivate patients, and support them via referral to an existing weight-loss programme. This will draw upon evidence from WP1, relevant literature and behavioural change models. Building on BWeL, I envisage three intervention components: EDUCATE: Clinician-patient 'script' to initiate the conversation and explain the link between psoriasis and overweight/obesity MOTIVATE: Encourage patients to accept referral to a weight-loss programme with an efficient referral pathway SUPPORT: Identify a weight-loss programme that sustains patient engagement and leads to weight-loss WP3: Randomised, controlled feasibility trial 45 people living with psoriasis and BMI≥27 kg/m2, randomised to receive the new intervention or usual care, will be sufficient to test the feasibility criteria: willingness to be randomised, fidelity of intervention delivery, retention. Secondary, exploratory outcomes include weight-loss, effect on psoriasis severity and quality of life. Qualitative interviews with patients in the intervention group and their clinicians, analysed thematically, will assess acceptability. Process evaluation, based on the logic model for the trial, will enable improvements to be made if it proceeds to a full trial. Dissemination I will present my results at national conferences and publish in peer-reviewed journals. I will work with the Psoriasis Association and British Skin Foundation to share results with patients, and with my PPI panel, university, and NIHR team to learn other ways to engage patients and the public. If indicated, I will apply for further funding.