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It is not clear why the TB health worker was not aware of the principles of PCC. If she had known that Bianca and her family were concerned about Bianca's emotions and health (and about how the health worker was addressing Bianca's request for medication), the health worker could have used PCC. This could have made Bianca feel that her concerns had been taken into account, and that it was important to her to be treated with dignity and respect. This could have reduced Bianca's emotional distress, and possibly also might have helped her to resolve her doubt about the medication. Bianca may also have felt reassured that her health was being dealt with appropriately.

The results of this study show that there was a general awareness of the PCC principles among the group, however, the application of the principles to the people interviewed in the present study was not consistent and the application was not aligned with the philosophy. The researchers have been working with the practice team to change the culture, practices and the environment of the practice to improve the way in which the PCC principles are implemented in the practice.

After the interview, the researcher discussed the findings with the medical practitioners involved in Bianca’s care. The medical practitioners suggested that it might be appropriate to consider a community context intervention, given Bianca’s vulnerability. The group interviewed for the present study was asked about their thoughts on the PCC principles, they identified that the principles needed to be more than a set of guidelines, but a philosophy that had to be embodied in the daily practice of the health professionals.

This case illustrates that PCC principles may not be implemented in practice. Bianca was not given the opportunity to question the need for or the impact of the treatment that she was offered. She did not understand why she could not just get better, or why she needed to finish the treatment. Bianca was not able to discuss the link between TB and HIV and the risk of infection in her relationship. Given her lack of understanding, Bianca was not able to make an informed decision about the treatment or to follow up with her GP to ensure that the treatment would not have an impact on her relationship with her partner. 827ec27edc