Observation of training session and huddles
VAE
SAID
By invitation of PACE-D study leads, and with prior agreement from trainers, VAE was introduced to participating health professionals, as noted above, as one of several observers of the local CSP training session for health professionals and of the first lunchtime huddle sessions convened by the trainers to give the health professionals an opportunity to discuss how CSP was going and share concerns or practical tips. Participants were told that the observation could help provide background understanding for the interview study and help inform interpretation of PACE-D trial findings and decisions about the use of CSP beyond the trial. We explained that we were not analysing who said what in the training sessions or huddles, and that no quotations would be used. VAE interacted conversationally with health professionals and trainers during refreshment breaks and was included in lunch arrangements for the huddle. She also participated occasionally, for example, stepping in to make up a pair and play the role of a patient for a role play exercise during the training session, briefly confirming during an early huddle that health professionals in the UK also reported variation in how much preparatory thinking patients did ahead of CSP conversations, and (more significantly) presenting the preliminary analysis from the interview study for discussion at the final huddle observed.A comprehensive set of slides and documents was provided for reference from the training. Note-taking from the huddles was handwritten, not formally structured, and brief. It focused on summarising topics of concern and key features of meetings (e.g. started late because clinics overran; some participants visibly very tired). Huddles were scheduled for an hour, but typically started late. In total VAE attended 7 of 11 huddles and watched recordings of 2 huddles that she could not attend in person. This amounted to approximately 6 hours of active meeting time observed.The observations helped to inform interview questions (for example, prompting inquiry about how CSP conversations were documented in medical records) and provided context to support interpretive analysis of interview data (particularly confirming the nature and strength of concern about logistical challenges, including those associated with long patient queues in clinic).We decided not to observe CSP consultations, both to avoid additional intervention in the context of the PACE-D trial and because the health professionals were already under significant pressure.