Strengths and limitations of methods
In the context of the PACE-D trial, we observed CSP training, interviewed all doctors and nurses who conducted more than a handful of CSPs (half of them twice) and observed a series of professional huddles. We generated a rich dataset that supported detailed examination of both commonality and variation in health professionals’ interpretations, enactments, experiences and evaluations of CSP, and enabled us to consider how these developed (or not) over time as familiarity with the intervention grew. What we heard from the health professionals involved in CSP conversations was consistent with what we learned from PACE-D coordinators and resonated for the CSP trainers (who also led the huddles). Our findings and key analytic points were endorsed by participants when we presented them at a PACE-D huddle.Important limitations were that we did not observe clinical enactments of CSP and did not attempt to link our interviews with health professionals to interviews with patients. Because the interviews were conducted in the context of the ongoing PACE-D trial, experiences of trial participation inevitably overlay participants’ experiences of CSP in clinical practice. This might have increased some participants’ emphasis on biomedical markers and experiences of tension between biomedical and patient priorities. It does not, we believe, undermine the robustness of our analysis and recommendations.