When CSP goes well: ‘ideal’ patient behaviours and outcomes
When asked early in their interviews for an example in which CSP went relatively well, participants gave strikingly similar responses. In both waves, all included most of the following elements: a patient comes to their CSP conversation actively ‘prepared’ (having read and reflected on their care planning letter), engages fairly readily in discussion, is willing to act to improve their health, proposes or works with the health professional to set relevant goals and a realistic action plan, leaves the CSP conversation motivated, sticks to their plan and sees (or would see) improvement in targeted biomedical markers at follow-up. A selection of these ‘good example’ accounts is provided in Additional Table In practice, of course, CSP did not always work along these lines. Participants consistently reported that only a minority of patients came to CSP appointments clearly familiar with their test results and able and willing to discuss ideas about their health, let alone set and stick to plans for health-related behaviour change that positively impacted their biomedical markers. Some participants seemed surprised by this and there was some variability in how and to what extent they became reconciled to it.We will return shortly to consider variations in patients’ engagement with CSP. First, though, we continue this section with a description of how health professionals compared CSP with their previous practice. We note both common ground and variation in their understandings and their own contributions to enactments of CSP, as well as in their recognition of its advantages.