Exploring the concept of patient centred communication for the pharmacy practice
Exploring the concept of patient centred communication for the pharmacy practice
Majanne Wolters 0
Rolf van Hulten 0
Lyda Blom 0
Marcel L. Bouvy 0
0 Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences , PO Box 80082, 3508 TB Utrecht , The Netherlands
Background Patient centred communication can improve pharmaceutical care, but is not well described for pharmacists. Aim of the review To provide a comprehensive and accessible overview of the concept of patient centred communication for the pharmacy practice. Method A scoping review and thematic analysis was undertaken to synthesize the extracted data and present it in a model. Results Literature search and selection resulted in eighteen articles. Thematic analysis of the extracted data led to five categories regarding patient centred communication. Two categories refer to phases of a pharmaceutical consultation: (1) shared problem defining and (2) shared decision making; three refer to underlying concepts and assumptions about patient centredness regarding (3) the patient, (4) the pharmacist and (5) the therapeutic relation. The categories were modelled in the so called Utrecht's Model for Patient centred communication in the Pharmacy. Conclusion Although there might be barriers to implement patient centred communication in the pharmacy, the concept of patient centred communication as described in the literature is relevant for the pharmacy practice.
Communication; Patient centredness; Pharmaceutical care; Pharmacy practice; UMPA model
Impacts of practice
Training of pharmacy staff in patient centred
communication may be helpful in addressing drug related
problems and achieving better health outcomes.
Patient centred communication by pharmacists may
enhance their role of care giver.
Communicating with patients about their experiences,
needs and concerns regarding their health and medication
is essential to identify drug related problems such as
overuse, adverse drug reactions and non-adherence [
Such communication is an important part of
pharmaceutical care: care which urges pharmacists to take
responsibility for the clinical outcomes of drug therapy by
preventing, identifying and resolving drug related problems
This was also explicitly recommended in a recent
Cochrane review. This review suggests that solely
providing information or education appears ineffective to
improve adherence or clinical outcomes [
]. There is
evidence that successful interventions combined patient
education with counselling [
]. In pharmacy practice different
kinds of interventions can be distinguished, such as
counselling when dispensing drugs or medication use review
services. Studies have shown that cognitive pharmaceutical
services improve the quality of drug therapy and outcomes
of several chronic diseases [
]. However, the improved
quality of drug therapy does not always seem to lead to
better patient outcomes. This may be caused by factors
concerning the illness or the patient’s lifestyle, but also by
difficulties that pharmacists experience with exploring
patients’ needs and concerns [
]. Almost half of the
studies about patient-provider interactions in pharmacy
practice focussed solely on information giving . All
this suggests that patient communication in pharmacy
practice needs improvement. The concept of patient
centred communication is widely advocated as a way to
improve communication [
2, 13, 14
Aim of the study
Patient centred communication is extensively described
and studied regarding doctors and nurses, but it is not well
defined for pharmacists. Bensing states that
patient-centredness is an ambiguous and multidimensional concept,
which is interpreted differently by individual caregivers
]. Therefore it might be difficult for pharmacists to
properly understand patient centred communication. The
aim of this study is to provide a comprehensive and
accessible overview of the concept of patient centred
communication for the pharmacy practice.
A scoping review was conducted. Scoping reviews ‘aim to
map rapidly the key concepts underpinning a research area
and the main sources and types of evidence available’ [
As Arksey and O’Malley stated, a scoping review is
suitable to summarize and disseminate research findings to
professionals, which is in line with the aim of our research
(Table 1) [
]. Table 1 contains a detailed description
of the six different phases of our scoping review, starting
with phase 1: determining the aim of the review.
In phase 2 a literature search was performed in Cochrane
and Pubmed database (respectively 12 and 21 February
2012) using a limited amount of search terms in order to
narrow the amount of references but still being able to
identify the main authors on patient centred communication.
For the selection of relevant articles (phase 3), articles
were screened judging whether they focused on
communication between health care provider and patient in general
and were published in English (based on title and abstract).
Excluded were articles about inter-professional
Not focussing on pa ent
centred communica on
Referring to earlier
descrip ons of pa ent
centred communica on
communication, e-health, management, aspects of patient
centred care other than communication or on specific groups
(patients, diseases, gender, culture) (see Fig. 1 flow chart).
Subsequently, full-text articles were read to determine
whether they conceptualized patient centred
communication (inclusion criterion). Articles were excluded when
referring to older articles and not giving a different or more
elaborate view on patient centred communication than the
Finally, through snowballing to earlier publications by
examining the full-text articles for relevant references,
articles were included that gave a different or additional
view on patient centred communication.
In phase 4 the text segments of the descriptions of
patient centred communication were extracted from the
selected articles. In phase 5 a thematic analysis of the data
was done until agreement was reached on all the
themes/categories. The different categories were
interconnected to one another and presented in a model. Finally, in
phase 6 stakeholders were interviewed individually for
feedback on this model.
Literature search and selection
The literature search and selection resulted in eighteen
articles describing the concept of patient centred
communication (Fig. 1).
Conceptualizing pa ent
centred communica on
Screening on tle and/or abstract
Reading full text
Total included ar cles
Thematic analysis including interrelating of the themes
From these articles the descriptions of patient centred
communication were extracted (See ‘‘Appendix 1’’.)
The thematic analysis of the data led to a total of 21
themes (Table 2). Combining similar themes led to five
main categories. Category 1 and 2 refer to two sequential
phases of the consultation process: the shared problem
defining (cat.1) and the shared decision making (cat. 2).
The other categories describe concepts or assumptions
about patient centredness and are related to the patient (cat.
3), the health care provider (cat. 4) or the therapeutic
relationship (cat. 5).
In the next paragraphs these five categories (and
underlying themes) are described in more detail.
The patient centred consultation
Category 1: Shared problem defining
The concept of ‘shared problem defining’ describes the
process of exploring and understanding the patient’s view.
The outcome of this process is a shared understanding and
agreement of the pharmacist1 and patient on the
problem(s) that need to be dealt with during the consultation
1 For reasons of readability ‘pharmacist’ was used instead of ‘health
care provider’ in the description of the results.
The problem-defining process includes the following
steps. At first, at the start of the consultation the pharmacist
(by active listening including questioning) encourages the
patient to be involved and thereby enhances the
relationship with the patient [
20, 21, 24–28
]. This stimulates
patients to express their expectations of the visit, their
problem(s) and concerns [
23, 25, 28
Next the pharmacist further explores the patient’s
perspective using active listening and summarizing
21, 24, 26, 29
]. Different topics may be addressed:
patient’s needs and concerns, practical problems, patient’s
knowledge and expectations about health and treatment or
the influence of the illness and/or therapy on their life
19–22, 24–26, 28–32
Subsequently the pharmacist considers the patient’s
situation and shares their expert opinion [
24, 28, 33, 34
To be sure that the patient comprehends the pharmacist’s
perspective on the patient’s problems, the pharmacist has to
give time for the patient to process the information and to
ask questions to be able to respond to the pharmacist’s
]. Shared problem defining may enhance
the role of pharmacists: their expert knowledge may add to
the patient’s perspective. In addition the pharmacist may
identify possible drug related problems the patient is not
Category 2: Shared decision making
The concept of shared decision making developed
alongside the concept of patient centred communication and is
extensively described as such. Several authors view shared
decision making as an element of patient centred
20, 23, 24, 32, 33, 35
]. Shared decision
making is an approach whereby the pharmacist encourages
the patient to actively participate and thus shares power and
22, 30, 36, 37
]. However, the pharmacist
has to consider the extent to which patients want to be
involved in choices [
20, 22, 26, 27
Patients need to be well informed, both before and
during treatment in order to be able to make an informed
decision about treatment of their illness
20, 21, 25–28, 31, 33, 34
]. The pharmacist should check
for comprehension and patients’ information needs, give
clear explanations and encourage questions
20, 21, 27, 28, 31, 33
Often there are different ways to treat and manage a
disease. Both the therapeutic options and patients
preferences should be taken into account by both parties
25, 27, 33
]. The patient may have specific requests,
experience (practical) barriers or is ambivalent [
23, 25, 28
The pharmacist, being an expert, can give information and
advice about the different (treatment) options, keeping in
mind the patient’s level of self-efficacy [
23, 27, 31
Finally, the patient and pharmacist should reach an
agreement on a management plan, which is concordant
with the values of the patient [
19, 21, 22, 28, 31, 33
Reaching an agreement includes the following three
Firstly, the pharmacist and patient should consider the
feasibility of the chosen solution. They have to discuss the
practicality of the plan, the follow up and plan for the
21, 24, 27–29
]. Secondly, the pharmacist
enables and encourages the patient to take responsibility
for the self-management of the disease [
19, 23, 30, 31, 35
Lastly, the pharmacist can summarize the agreements and
ask for feedback, in order to check agreement [
21, 24, 29
Underlying concepts and assumptions
The following concepts and assumptions about patient
centredness underpin and support the patient centred
consultation and refer to the patient, the pharmacist and the
Category 3: Related to the patient
The pharmacist should consider patients from a
biopsychosocial perspective, and not solely from a biomedical
21, 22, 35, 36
]. Secondly, pharmacists adapt
their care taking into account how the illness and
medication affect the individual patient. This is described in
terms as understanding the whole person, the patient as a
person, or a holistic approach [
20, 32, 35, 36
] Thirdly, the
idea of health promotion fits in with this: not only treating
the presented disease, but considering the health and
quality of life of the patient in total, now and in the future
19, 20, 32
Category 4: Related to the pharmacist
The concept pharmacist-as a-person relates to two
aspects. Firstly, that it matters to patients who the
pharmacist is as a person [
]. Secondly, pharmacists need
to take care of themselves and reflect on their own
feelings, values and actions (reflective practice) [
21, 24, 29
The pharmacist needs to be competent, not only in
pharmacotherapy, but also in communication skills
23, 27, 34
]. Special attention is given to being
empathetic, because this is essential for building an effective
23, 25–28, 31
Category 5: Related to the therapeutic relationship
A pharmacist should be able to establish a relationship
with the patient to have an effective consultation
19–21, 27, 29, 32, 34
]. This therapeutic relationship is
not only a prerequisite to a patient centred consultation.
The relationship in itself can have a therapeutic effect
]. Horvath et al.  described the therapeutic
alliance as the emotional bond developed between a
health professional and patient that allows the patient to
make therapeutic progress. Trusting the pharmacist is
an important aspect of the therapeutic relationship.
Patient’s trust in the pharmacist and confidence in their
expertise will help to trust the proposed treatment
27, 31, 34
Although it is important to take the wishes of the patient
into account, the pharmacist and patient have to act within
the given context. This means being realistic about time
and resources and taking into account (personal)
limitations and requirements [
The UMPA model
The categories and underlying themes were modelled in the
so called Utrecht’s Model for Patient centred
communication in the Pharmacy 2 to give an accessible
overview (Fig. 2. UMPA model). The consultation with
stakeholders led to minor changes in design and wording.
The current study provides an overview of patient centred
communication, based on the descriptions found in
eighteen publications. The different descriptions of patient
centred communication have been translated to pharmacy
practise and are presented in a model for the
pharmaceutical consultation, the so called UMPA-model (Utrecht’s
Model for Patient centred Communication in the
Pharmacy). Central in this model are shared problem defining
and shared decision making. These are supported by
assumptions about patient centredness regarding the
patient, the pharmacist and the therapeutic relationship.
The six phases of a scoping review were performed as
described by Arksey and O’Malley and by Levac [
Although a limited literature search was done, we argue
that the main descriptions on patient centred
communication were identified, because of extensive snowballing until
The process of study selection and the thematic analysis
was done by a small team, therefore there might be a risk of
bias. The feedback of the stakeholders however showed
that the model has face value.
When describing patient centred communication there is
the risk of oversimplifying and consequently not doing the
concept justice [
]. However, the included data were rich:
some authors focussed on the consultation and practical
skills (e.g. Makoul et al.) [
], others more on theoretical
notions on patient centred communication (e.g. Mead and
], sometimes it was mixed (e.g. Epstein and
]. We did justice to the complexity by using all
The included articles described patient centred
communication mostly for doctors or for health care providers
in general. We argue that it is also applicable to pharmacy
Firstly, pharmaceutical patient care aims at optimising
the outcomes of drug treatment for the individual patient.
When a patient experiences problems with medication, a
pharmacist can help to solve these problems by
communicating with the patient (e.g. by giving information,
reassurance or advice, by motivating or by solving
2 The model was named the UMPA-model, where UMPA is an
acronym of Utrecht’s Model for Patient centred Communication in
the Pharmacy (in Dutch Apotheek). (UMPA also seems to be Gaelic
for ‘about them’, which is an appropriate thought considering patient
Secondly, although one may question to what extent
pharmacists are involved in shared decision making,
which often seems to refer to decisions on treatment
22, 25, 27
], in our view pharmacists have a specific role
as health provider and they as well as other health
professionals help patients to make decisions regarding
treatment, e.g. managing the drug regimen. We argue that
a pharmacist can play an active role in defining the
specific drug problems and solve them together with the
patient, which is in line with the two phases of a patient
Finally, in the pharmacy practice pharmacists monitor
and evaluate patient’s medication use and therefore they can
signal possible problems of which the patient is not aware.
Therefore it might be that the consultation does not start with
a request for help from the patient, but with the pharmacist
exploring whether there is a problem, e.g. under
consumption. However, none of the authors stated that it is a requisite
for patient centred communication that the patient always
have to bring in the problem theirself. And even so,
especially in this kind of situations the pharmacist has to take the
steps of shared problem defining to determine together with
the patient what the exact problem is, which makes the need
for patient centred communication even bigger.
In our view these characteristics that are specific for
pharmaceutical patient care, do not change the suitability
of patient centred communication to pharmaceutical patient
Nevertheless one could argue that there are practical
objections that might hinder patient centred
communication in the pharmacy practice. Firstly, it could be more
difficult to build a relationship with patients because they
communicate with different staff members. Secondly,
patients may be reluctant to discuss their problems, due to
the poor privacy conditions in pharmacies. Thirdly,
communication may be hampered when staff is busy and
do not seem to have time for consultation. Fourthly,
patients do not always collect the medication themselves
which may limit the communication about patients’ drug
problems/questions. Lastly, patients may be unaware of
the possible support of the pharmacy staff to resolve their
drug related problems. Therefore they do not always have
an explicit wish for help or consultation of the
Pharmacists have to put more effort into connecting with
the patient to overcome these barriers to patient centred
communication. Therefore training of pharmacy staff is
useful, but it is also important to rethink the organisational
process of preparing and delivering medications to patients
in the pharmacy. All this does not proof the concept of
patient centred communication less valuable for the
pharmacy practice, but implementing patient centred
communication in practice needs attention to overcome these
Patient centred communication is a new concept for the
pharmaceutical consultation. According to the literature, it
refers to both the consultation process with the phases of
shared problem defining and shared decision making, and
to underlying concepts and assumptions regarding the
patient, the pharmacist and their relationship. All themes
from the thematic analysis seem to be relevant for the
pharmaceutical practice, although there might be barriers
to implement patient centred communication in the
pharmacy. The UMPA-model can be helpful in presenting
patient centred communication and supporting (future)
pharmacists to understand the requirements for patient
centred pharmaceutical care, not only as a practical set of
communication skills or phases in a consultation, but also
as a principle and attitude towards pharmaceutical care.
Conflicts of interest None.
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See Table 3.
Building a relationship [requires an awareness that ideas, feelings, and values of both the patient and [
the health care provider influence the relationship]
Creates effective therapeutic relationships with patients [creates trust]
21/Handling within the given context
‘‘Being realistic’’ about personal limitations and issues such as the availability of time and resources [
Use time and resources appropriately, during the consultation and long term
a The words ‘doctor’ and ‘physician’ were replaced by ‘health care provider’ thus translating the descriptions to health care in general
b The segments of data of the articles are numbered in chronological order of publication year. Segments containing different themes are marked
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