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139 Pharmacists’ involvement in shared decision making: a scoping review
  1. Léa Langlois1,
  2. Valérie Carnovale1,
  3. Theo Stefan1,
  4. Michèle Dugas1,
  5. Patrick Blouin1,
  6. Marie Baron1,
  7. Marie France Demers3,4,
  8. Michael Gionfriddo5,6,
  9. Aline Kaufmann1,
  10. Laury Boily-Carette1,
  11. Jean-Philippe C Lavoie1,
  12. Louis S Rivard1,
  13. Olha Svyntozelska1,2,
  14. Audrey Turmel1,
  15. Laurie Voyer1,
  16. Juliette Demers1,
  17. Jenny Jin1,
  18. Patricia Erwin5,
  19. Larry Prokop5,
  20. Annie Leblanc1,2
  1. 1VITAM Research Center for Sustainable Health, Integrated University Health and Social Services Center, Quebec, CA
  2. 2Faculty of Medicine, Laval University, Quebec, CA
  3. 3Faculty of Pharmacy, Laval University, Quebec, CA
  4. 4CERVO Brain Research Center, Quebec, Canada
  5. 5Mayo Clinic, Rochester, USA
  6. 6Pharmacy department, Duquesne University, Pittsburgh, USA

Abstract

Introduction Pharmacy practice has evolved considerably in many healthcare systems, moving towards more direct involvement in patient care. Shared decision-making (SDM) is an essential part of high-quality, patient- centered care. This study aimed to assess the manner and the extent to which pharmacists are involved in SDM, and the barriers and facilitators to their involvement.

Methods We conducted a scoping review using the methodology from the Joanna Briggs Institute and included any type of document about SDM in pharmacy or involving pharmacists, provided that SDM was explicitly mentioned. Searches were carried out on MEDLINE, Embase, Cochrane RCT and Systematic Review. Pairs of reviewers independently screened documents and extracted data. A descriptive analysis of study characteristics and a thematic analysis of content relevant to the objectives was performed.

Results A total of 302 references was evaluated for eligibility, with 28 full-length papers reporting on 24 studies included for analysis. SDM was infrequently performed with patients and with other healthcare professionals as part of multidisciplinary teams. Pharmacist-led SDM interventions described in the literature consisted mostly of medication reviews with the goal of deprescribing in older patients, and discussion of treatment options or management issues with patients initiating chemotherapy, at risk or living with diabetes, and taking antidepressants. Barriers and facilitators concerned pharmacists’ attitudes towards SDM, interprofessional collaboration, relationships with patients, skills and resources.

Discussion While infrequent, pharmacist participation in SDM is possible and beneficial, specifically where complex medication decisions need to be made while considering patients‘ goals, such as the treatment of chronic conditions or the reduction of potentially inappropriate prescribing. To facilitate their full participation, many challenges must be addressed.

Conclusion This review did not find evidence that pharmacists widely practiced SDM, but suggested some avenues for their involvement, consistent with the expanding scope of pharmacy practice.

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