‘The way you talk, do I have a choice?’ Patient narratives of medication decision-making during hospitalization

ABSTRACT

Objective

Based on the principle of the autonomy of the patient, shared decision-making (SDM) is the ideal approach in clinical encounters. In SDM, patients and healthcare professionals (HCPs) share knowledge and power when faced with the task of making decisions. However, patients are often not involved in the decision-making process. In this study, we explore medication decision-making during hospitalization and how power in the specific patient—HCP relationship is articulated, as analysed by Foucauldian theory.

Methods

A qualitative case study, comprising observations of patient-HCP encounters at an internal medicines ward at a university hospital in Norway, followed by semi-structured interviews. The narratives (n = 4 patients) were selected from a larger study (n = 15 patients). The rationale behind the choice of these patients was to include diverse and rich accounts. The four patients in their 40s–70s were included close to the day of presumed discharge.

Results

The narratives provide an insight into the patients as persons, their perspectives, including what mattered to them during their hospitalization, especially in relation to medications. Overall, SDM was not observed in this study. Even though all the participants actively tried to keep their autonomous capacity and to resist the HCPs’ use of power, they were not able to change the established dynamics. Moreover, they were not allowed an equal voice to those of HCPs and thus not to escape the system’s objectification and subjectification of them.

Conclusion

There is a need for HCPs to get more familiarized with SDM. The healthcare system and the individual HCP need to make more room for dialogue with the patients about their preferences. A part of this is also how health care systems are structured and scheduled, thus, it is important to empower patients and HCPs alike.

KEYWORDS:

• Hospital discharge
• medication communication
• patient perspective
• shared decision making
• Foucault

Acknowledgments

We thank the people included in the study for their time and contributions and the hospital ward for facilitating the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the The study has been funded by the Hospital Pharmacies Enterprise, South-Eastern Norway and the University of Oslo. .

Notes on contributors

Stine Eidhammer Rognan

Stine Eidhammer Rognan MScPharm. She has twelve years’ experience from hospital pharmacy of which ten years as a clinical pharmacist at several medical and surgical wards. Medication communication aiming to increase patient’s self-management after discharge has been an interest since long before she started her PhD-project, e.g. counselling patients about warfarin as newly prescribed treatment after heart surgery. She has worked with patient communication recommendations for clinical pharmacists in the Hospital Pharmacies Enterprise. In her PhD-project, she focus on patient safety and more holistic and individualized health care services.

Mie Jedig Jørgensen

Mie J. Jørgensen, MScPharm. She started her interest in social- and clinical pharmacy during her studies at Copenhagen University. She has an interest in communication and therefore chose to focus on this during her studies, specifically on the communication between health care professionals and patients. Currently, she works at a local pharmacy where she helps patients to obtain the knowledge they require about their medication and health in order to be more empowered and compliant.

Liv Mathiesen

Liv Mathiesen, is an assistant professor in Clinical Pharmacy, at the Department of Pharmacy, University of Oslo. She is the lead of the research group of clinical pharmacy, which focus on patient experiences and attitudes towards drugs, and interventions to optimize the individual’s drug therapy. Her experience includes both qualitative and quantitative research, in particular randomized controlled studies. She is also an associate editor for the European Journal for Hospital Pharmacy. Former work experience includes being the head of research and development in the Hospital Pharmacies Enterprises, South-Eastern Norway, senior clinical advisor at the Norwegian Medicines Agency, as well as alternate member of the Committee for Human Medicinal Products at the European Medicines Agency.

Louise C. Druedahl, PhD, MScPharm, is a pharmacist and regulatory scientist who is specialized in research in the intersection between science and law. She has a research interest and experience with studying the patient perspective and applying social science theories such as works of Michel Foucault. Her research interests also include regulatory challenges related to regulation of medicines and medical devices as well as how to regulate emerging technologies for these types of products. Louise works with both qualitative and quantitative data, but she is particularly experienced with qualitative methodology. She is currently a PostDoc.

Louise Christine Druedahl

Louise C. Druedahl, PhD, MScPharm, is a pharmacist and regulatory scientist who is specialized in research in the intersection between science and law. She has a research interest and experience with studying the patient perspective and applying social science theories such as works of Michel Foucault. Her research interests also include regulatory challenges related to regulation of medicines and medical devices as well as how to regulate emerging technologies for these types of products. Louise works with both qualitative and quantitative data, but she is particularly experienced with qualitative methodology. She is currently a PostDoc.

Helene Berg Lie

Helene B. Lie, MScPharm, started her career at a local pharmacy where she saw the importance of good communication between patients and healthcare professionals to ensure correct medication use. The motivation for her Master’s thesis topic came from a burning interest in knowing more about what influences adherence after discharge and to learn more about how we can ensure correct and safe medication use for the patient at home. Currently, she works as a clinical pharmacist, with medication reconciliation and medication reviews.

Kajsa Bengtsson

Kajsa Bengtsson Pharm, started her career at the department for hospital supply at Oslo Hospital Pharmacy. Her interest in health communication and clinical pharmacy started during her studies at Oslo University. In doing her master’s thesis, she had a special interest for researching communication between health care professionals and patients during hospital discharge including health literacy and patient’s different understanding of health information. Currently, she works as a clinical pharmacist were she has a high focus on health communication, adapted to the individual patient’s knowledge base.

Yvonne Andersson

Yvonne Andersson, She is Head of Research and Development at Hospital Pharmacies Enterprise, South-East Norway. She is an accomplished senior researcher and science administrator. Her research is primarily aimed at patient safety and the development of new medicines. Her research also includes qualitative studies with focus group interviews and observational studies.

Sofia Kälvemark Sporrong

Sofia Kälvemark Sporrong, She is professor in Social Pharmacy at Uppsala University, Sweden. From her Ph.D. dealing with moral distress in health care professionals she has continued researching health care professions and their roles, in particular pharmacists. Her research interests are also in patient-provider communication in health care and pharmaceutical policy. Coming from social sciences, Professor Kälvemark Sporrong is experienced and interested in qualitative methodology, not least its use within medicine and pharmacy research traditions.