CSP training, professional huddles and PACE-D coordinator support
Health professionals spoke positively about the CSP training they received and the promise of the approach that it conveyed. Some described starting to use some of the ideas and techniques they learned immediately – before patients had been recruited for PACE-D. There were, however, some challenges associated with the training and support provided for health professionals which we note here.For some participants, a time lag between the training and their first formal CSPs with patients meant they perhaps forgot some ideas and techniques and lacked confidence before they started in earnest. Several participants also reported “getting rusty” during periods of leave or secondment and having to rack their brains to remember what CSP entailed when they returned to the teamlet.Some health professionals commented in interviews that the scenarios used in training were simpler than those encountered in the clinic where patients did not all follow an ideal kind of script. During the final huddle at which these findings were shared, members of the training team shared a reflection that perhaps they had painted too rosy a picture and so set up too high expectations during the first CSP training session.The huddles, intended as supportive sharing and learning opportunities, were scheduled for lunchtimes, with food provided. Health professionals typically arrived late as morning clinic sessions ran over time, and they were often visibly tired. In the first huddles, a few practical challenges and questions were raised and addressed, including how to encourage patients to engage with their results information ahead of the consultation (which led to an arrangement that PACE-D coordinators could print a copy of the letter when patients checked in for their appointment and support them to review test results and think about questions or goals before seeing the doctor or nurse). In later huddles, partly in response to insights emerging from this study, CSP trainers shared short videos and presentations encouraging reflection on empathy and goal setting (including attention to goals beyond the biomedical) and examples of completed goal and action plan pages.