Fosgerau Christina Fogtmann, Husted Gitte Reventlov, Clemmensen Nanna Broch, Rossing Charlotte Verner, Kaae Susanne
PhD. Associate Professor, University of Copenhagen, Denmark.
PhD. Consultant Research and Development, Pharmakon - The Danish College of Pharmacy Practice, Research and Development, Denmark.
Pharm Pract (Granada). 2021 Oct-Dec;19(4):2582. doi: 10.18549/PharmPract.2021.4.2582. Epub 2021 Dec 13.
For patient centered counseling to take place in community pharmacies, patients should feel encouraged to share their perspectives, yet studies show that this rarely happens. The process of patient perspective sharing relies on the interactional details that unfold during an encounter i.e. how patients verbally and nonverbally are encouraged to share their perspective, which in turn is affected by patients' and pharmacy staff members' psychological processes in the situation, i.e. how they perceive and feel when acting. Therefore, employing complimentary methods that study both interactional and psychological processes could deepen the understanding of the dynamics governing patients' perspective sharing in pharmacy encounters.
The objective of this study is twofold: 1) a methodological consideration of the benefits of employing Conversation Analysis (CA) and Video-Stimulated Recall Interviews (VSRI) in parallel, 2) to use the methodological combination to understand patient perspective sharing in community pharmacy interactions.
A single case study of one pharmacy encounter to explore the objectives in-depth. This was done through video recording of pharmacy encounters and subsequent CA-analysis; VSRIs were conducted with the involved patient and pharmacy staff member and analyzed using a qualitative thematic approach.
By exploring detailed interactional and psychological processes in parallel, specific occurrences which might hinder patients' perspective sharing were revealed. CA demonstrated that staff member's listening activities restricted the patient's perspective sharing. VSRIs with patient and staff member supported this result: the staff member had a narrow conception of what counted as suitable answers and did not consider listening an active process. The patient harbored shame about needing to take the medication which affected her behavior during the encounter.
The novelty of the methodological combination is promising in order to grasp the complex process of patient perspective sharing in pharmacy encounters, as it affords aspects such as emotionality to be considered a central part of pharmacy encounters. As a consequence, it is suggested that the psychological concept of mentalizing is added to pharmacy education, as it is a trainable capacity enabling staff to become aware of the mental states that affect both patients and staff themselves during the pharmacy encounter.
为了在社区药房开展以患者为中心的咨询服务，应鼓励患者分享他们的观点，但研究表明这种情况很少发生。患者观点分享的过程依赖于咨询过程中展现的互动细节，即患者如何通过言语和非言语方式被鼓励分享观点，而这又受到患者和药房工作人员在该情境下的心理过程的影响，也就是他们在行动时的感知和感受。因此，采用研究互动过程和心理过程的互补方法，能够加深对药房咨询中影响患者观点分享动态过程的理解。
本研究有两个目的：1）从方法学角度考量同时运用会话分析（CA）和视频刺激回忆访谈（VSRI）的益处；2）运用这种方法组合来理解社区药房互动中患者的观点分享情况。
对一次药房咨询进行单案例研究以深入探究上述目的。通过对药房咨询进行视频记录并随后进行会话分析；对参与的患者和药房工作人员进行视频刺激回忆访谈，并采用定性主题分析法进行分析。
通过并行探究详细的互动过程和心理过程，揭示了可能阻碍患者观点分享的具体情况。会话分析表明工作人员的倾听行为限制了患者的观点分享。对患者和工作人员的视频刺激回忆访谈支持了这一结果：工作人员对合适答案的定义很狭隘，且不认为倾听是一个主动的过程。患者因需要服药而感到羞愧，这影响了她在咨询过程中的行为。
这种方法组合的新颖之处在于有望把握药房咨询中患者观点分享的复杂过程，因为它将情感等方面视为药房咨询的核心部分。因此，建议将心理化的心理学概念纳入药房教育，因为它是一种可培养的能力，能使工作人员意识到在药房咨询过程中影响患者和工作人员自身的心理状态。
