In today’s healthcare delivery systems, pharmacists are required by law to educate patients on prescription drug therapy. Pharmacists often educate their patients by making declarative statements. The activity in which pharmacists make declarative statements to patients about what they should do or how they should behave in relation to their disease state and drug therapy is known as “patient counseling”. Patient counseling by pharmacists may include but is not necessarily limited to a general description of the medication dispensed, directions for use, storage requirements and common adverse effects. Not surprisingly, pharmacists experience difficulties counseling patients with psychiatric disabilities, for example those with depression, schizophrenia, or bipolar disorders. Such difficulties are related to patients’ cognitive, expressive and/or receptive capacities. As patients are increasingly involved in their own medical care, pharmacists might have to counsel patients with psychiatric disabilities on a daily basis. Therefore, it is necessary to train future pharmacists to communicate effectively with those patients. Thus far, there have been a few studies on counseling patients with psychiatric disabilities.
This article reports on a research process in which a formal consensus technique was used to achieve consensus and develop a core list of linguistic and nonlinguistic recommendations to be used during training future pharmacists to counsel patients with psychiatric disabilities in order to improve their communication skills with those individuals. This was a descriptive study using the Delphi technique. The main outcome measure was agreement or disagreement of a panel composed of pharmacy educators, practicing pharmacists and pharmacy students on a series of recommendations to reach consensus and develop a core list of recommendations to be used in pedagogic and during training sessions of future pharmacists on counseling patients with psychiatric disabilities.
The Delphi technique is a formal consensus technique that is carried out in iterative rounds. In the first Delphi round, often termed as opinion generation round, key contacts were interviewed and their views and recommendations on counseling patients with psychiatric disabilities were explored. An extensive literature review was conducted to gather all potential recommendations. These potential recommendations together with those provided by the key contacts interviewed in the first round were compiled into a questionnaire. The questionnaire was delivered in a second Delphi round to a panel of pharmacy educators, practicing pharmacists and pharmacy students and each panelist was requested to indicate the level of his/her agreement or disagreement on the proposed recommendations using a nine-point scale (1 indicated strong disagreement and 9 indicated strong agreement). Equivocal recommendations were included in a revised questionnaire in a third Delphi round and each panelist was asked if he/she wished to change his/her agreement or disagreement in view of the scores of other panelists. Analysis of the iterative process showed that consensus was achieved to include 36 (78.3%) of the 46 proposed recommendations in the core list. Panelists agreed that recommendations related to: 1) becoming aware of the cognitive, receptive and communicative capabilities of the patient, 2) choosing vocabulary and communication pace, 3) using gestures and facial expressions, and 4) dealing with particular communicative situations should be included in the core list. Moreover, general communicative recommendations related to tone, style and politeness were also included.
In this study, consensus was reached on a core list of essential recommendations to be used while training future pharmacists to counsel patients with psychiatric disabilities. Utilizing such consensual recommendations might enhance communications with those patients and promote congruence in daily clinical practice.