Benefits of CSP beyond improvements in health behaviours and biomedical markers
DISEASE
Between them, participants identified various benefits of CSP independent of (but perhaps intermediate to) changes in patients’ health-related behaviours and improvements in biomedical makers. Benefits identified by at least some health professionals included patients: being better informed; feeling less rushed, more listened to and better respected; sometimes appreciating that “the doctor is caring for them more, caring not for the disease but more emotionally” (HP Seow, w2); and sometimes being encouraged and enabled to feel and take more ownership of their conditions. Some health professionals also reported gaining a better understanding of each patient’s situation and perspective, which could in turn help them: (occasionally) solve previously baffling diagnostic puzzles; avoid unwarranted judgementalism; avoid alienating and demoralising patients; build rapport and trust; tailor suggestions more appropriately to patients and their situations; and “leave the door open” for people to come back for support in the future. Several doctors who stressed the value of these more emotional, relational and perhaps intermediate experiential benefits for patients also commented appreciatively on CSP as a better way of practising, an approach that reflected why they came into medicine, and one that could leave them feeling more satisfied with their encounters with patients and their work more generally (see Table Broader benefits of CSP (beyond improvements to patients’ health-related behaviours and biomedical markers)“I will get to hear more about what really concerns the patients. Yeah. So maybe they feel that now they have more time, or more of an opportunity to voice out their concerns… or they were more likely to talk about it compared to a normal consult where they might feel they were a bit rushed… So I get to understand the patients more.… Spending a few minutes to find out what their preferences are, what their values are, this gives us a better idea of what we’re dealing with and then how to manage these patients subsequently… (HP Ho, w1)I do get a feeling that they feel that if for once they have been given the opportunity to talk more to the doctor, and let the doctor know about their side of the story, how they feel about things, they will get more satisfaction from that. Yeah. And the doctor is listening [laughs]. I think from the patient's point of view, they always like it when the doctor is listening [laughs].” (HP Ho, w1)Patients have time and opportunity to voice concerns.Health professionals can better hear and understand.Patients may be more satisfied.Patients can talk about what matters to them.Patients may appreciate being listened to.Health professionals can avoid demoralising patients.Health professionals can investigate rather than dismiss sources of upset.Health professionals can listen to and learn from patients.Health professionals can show empathy and develop rapport with patients.Health professionals can enjoy work more; this way of working can benefit professional wellbeing.Variations in health professionals’ comments about these broader benefits of CSP seem to reflect variations in both their views of the purposes of CSP and their conduct of CSP conversations. It seems plausible at least that the broader benefits will be more readily realised and recognised when health professionals are more strongly committed, and have a deeper understanding of what it takes, to work in respectful partnerships, relate to patients as experts in their own lives, and take seriously patients’ own priorities for their health and wellbeing. The broader benefits will also carry more evaluative weight if these commitments are considered morally significant. We take the commitments to be consistent with the person-centred ambitions of CSP.We will return to “