Patient experiences of shared decision making with primary care clinical pharmacists
Peter S Loewen, Arwa Nemir, Anita I Kapanen, Peter J ZedAbstract
Background
Shared decision making (SDM) is a core element of patient-centred care, aligning treatment decisions with patients’ preferences and values. Primary care clinical pharmacists (PCCPs) are well positioned to support SDM within interprofessional teams. This study examined patients’ experiences of SDM with PCCPs in British Columbia's Pharmacists in Primary Care Network (PCN) Program and factors associated with those experiences.
Methods
A cross-sectional survey was distributed to patients who completed an appointment with a PCCP between May 2022 and September 2023. Those who reported that a decision was made about their care completed the nine-item Shared Decision Making Questionnaire (SDM-Q-9). Linear regression with Box–Cox transformation identified demographic, psychological, and clinical factors associated with SDM-Q-9 scores. Subgroup analyses were conducted by age and appointment type.
Results
Of the 2714 patients invited, 823 responded, 630 were eligible, and 604 completed the SDM-Q-9. The median total score was 77.8 (IQR 62.2–91.1), indicating moderately strong agreement that SDM occurred. Unadjusted analyses showed higher SDM scores among patients aged <65 and those with in-person appointments. In adjusted models, demographic and clinical factors explained little variance (adjusted R2 = 0.05), whereas psychological factors—such as expectations of the PCCP, understanding of medications, motivation to engage with community pharmacists, and overall experience—accounted for most variance (final adjusted R2 = 0.39).
Conclusion
Patients reported high levels of SDM with PCCPs. Experiences were driven mainly by perceptions and beliefs rather than demographics or clinical complexity, suggesting PCCPs engage patients equitably and strengthen collaborative medication decision making.