Table 2 Broader benefits of CSP (beyond improvements to patients’ health-related behaviours and biomedical markers)

“It didn’t exactly go that well, but it was a case of when I looked at the patient’s problem in an open-ended manner and allowed her to speak, she said something like ‘this condition is something that I need to work on myself, it’s not something that other people can do for me’. And I think ‘Yeah’. And even though at the end of that conversation, there wasn’t a goal set or a plan made, I think it was a good step…. So previously it would be ‘OK, these are your results, these are your medications, I think we should shift, we should adjust the medications this way, I think these are what you should be working on’. Now we have flipped it around and ask ‘What is important to you?’, ‘What would you like to work on?’. I think that makes a lot of difference. When you throw the ball into the patient’s court, I think it forces them to think about what it is about their conditions that they want to work on. Whereas I find that if the doctor is the one telling you, ‘OK, this is what you should do’ the patient just reverts to being defensive, say ‘OK, I don’t want to do that’.” (HP Wu, w2)

When patients are asked openly, they may start to think about what is important to them and what they can do in relation to their condition (even if they don’t get as far as making specific plans).

“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.

“What was interesting about this particular conversation was it turned to his things about [home situation], family matters. Things that weren’t purely about diabetes but they mattered to him. So it was positive in that sense because it allowed him to speak quite freely about these things… He is not with family, so the opportunity to be listened to would probably, I’m guessing, be quite precious to him… I listened to him, yes, I did, and I think he appreciated being listened to” (HP Ang, w1)

Patients can talk about what matters to them.

Patients may appreciate being listened to.

“I have conducted some non-PACE-D consults where I was too engrossed in HbA1C… we have only that 5 minutes and I will just go straight to that point, ‘Okay, HbA1C is going up. It's not just going up, it's already in the terrible range’, and you could see how the patient responded and patient obviously had previous consults where the doctor has hunted them down, made them so demoralised and they just hate coming to the clinic… If we are going to venture into … asking them, ‘Why are you so upset?’ and things like that… that would need more time in the normal consults. So, often time we will be quite dismissive, … we will just say, ‘Okay, let's do this. Let's increase the medicine’ and things like that… Overall, it's yet another, I would say, negative consult, and patient get more and more depressed. So that doesn't help with the diabetes. But what I see from PACE-D … I don't see any patients going out of the room feeling downcast or adverse to this consult.” (HP Seow, w2)

Health professionals can avoid demoralising patients.

Health professionals can investigate rather than dismiss sources of upset.

“I think the approach is sort of quite novel lah. Actually useful lah. Because I mean we used to think differently. So now at least we think that maybe we shouldn't be saying too much. Let the person talk. And if possible we try to sort of examine their ambivalence and if they got something, we don't argue, we try to roll with them. Maybe next time then there's more confidence and trust that - listen to them more, maybe it will help. So, CSP help us at least to learn some of these skills lah.” (HP Toh, w2)

Health professionals can avoid unfruitful arguing, work with patient to explore their reasoning, and build therapeutically useful trust.

“CSP makes me feel like I'm doing what a doctor should do... We have been trained to help people, we have been trained to listen to patients with open ended questions, to get a story out of them, to understand individual circumstances, to deliver individualized treatment… But because of systemic issues, because of timing issues, we have been always limited in the ability to deliver that. And therefore, our practice has evolved into a more paternalistic kind of approach, which, in my opinion is effective, is fast, but not the most ideal. CSP allows me to do what I've been trained to do: to work with people, not to dictate people's life.” (HP Boon, w2)

Health professionals can listen, understand and work with people in the ways they think they should.

“I have more time to show empathy to the patients and to really care for the patients rather than just mundanely go through the steps of the targets and the numbers. And often times, we can hear what patient is sharing. Even though it is not something to do with the illness itself, I feel that the consult is more joyful and it’s probably more education for me… I feel that if they benefit from it, even if just emotionally, I feel that that makes my day in that sense … I mean, you see patients 5 days a week, 8 hours a day. Sometimes, you can get so it's just like a chore. We just see patient and patient and patient - it's just like a factory. But this adds more meaning to what we do. And sometimes we just need to take it slow and value what we do… I think that helps with our own, I would say mental health, to a certain extent… maybe it helps us to look forward coming to work to spend time with patient… I mean it helps us to know that the patient knows that they are cared for… there is a proper doctor-patient relationship, there is rapport … So, that's way, way different from just seeing numbers, seeing patients as just clearing the queue.” (HP Seow, w2)

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.