Expressing and negotiating face in community pharmacist-patient interactions.

BACKGROUND: A collaborative patient-pharmacist interaction is fundamental to greater patient satisfaction with pharmacy care and improved medication adherence. Effective pharmacist-patient communication occurs when both pharmacist and patient are able to successfully attend to not only the typical tasks and goals of the interaction but also basic face needs that underlie all social interaction; autonomy, competence or esteem, and fellowship. Addressing face needs occurs through conventional and strategic communication strategies that respond to the emerging needs throughout an interaction. Pharmacist-patient interactions are not just about transfer of information and medications. Both parties assess the situation, the others' intentions within the context of their own goals and this influences how they choose to act throughout the interaction. Face-work Theory provides a framework to understand these interaction processes in pharmacist-patient communication. OBJECTIVES: The aim of this study was to determine face needs, threats and the strategic communication strategies used to address these within community pharmacist-patient interactions. METHODS: This exploratory descriptive study drew upon principles of ethology to first describe naturally occurring behaviour and then to interpret this behaviour within the context of Face-work theory. Twenty-five audio-recorded community pharmacist-patient interactions were collected and analyzed. The average length of these interactions was 3:67 min with a range of 0.39 s-9:35 min. RESULTS: Multiple face needs for both pharmacist and patient were evident in most interactions. Autonomy, competence and fellowship face needs were negotiated in the following contexts: participative relationships, concordant role expectations, sensitive topics, and negotiating expertise and knowledge. Competence face needs for both parties were the most dominant need found in negotiating role expectations. The most common communication strategies used to support face were solidarity based strategies while indirect and depersonalized questions were commonly employed to mitigate face threat. IMPLICATIONS AND SIGNIFICANCE: Face-work Theory is a novel approach to understand processes and outcomes of patient-pharmacist interactions in community pharmacies. Linking speech acts with face needs and threats may help to elucidate how pharmacist-patient interactions achieve both task oriented and interpersonal goals.

A meta-narrative review of recorded patient-pharmacist interactions: exploring biomedical or patient-centered communication?

BACKGROUND: Pharmacists worldwide require improved patient-centered communication skills as they transition from a dispensing role to enhanced involvement in patient care. Researchers have studied pharmacist communication through audio and video recordings of patient-pharmacist encounters. A meta-narrative review of research using these recordings will offer insight into the extent of biomedical vs. patient-centered communication in patient-pharmacist exchanges. OBJECTIVES: This review aimed to characterize research on patient-pharmacists interactions using audio or video recordings and explore the 1) focus of research questions, 2) study design, 3) data analysis methods, 4) main findings and 5) presence of patient-centered vs. biomedical models of interaction. METHODS: Drawing on the principles of meta-narrative systematic review, a literature search was performed to identify studies published in English. No publication date limits were implemented. Key search terms included: "audio recording", "video recording", "communication", "patient counseling", "patient interaction", "discourse analysis", "conversation analysis", "narrative analysis", and "content analysis". The search was conducted in five databases: Medline, Embase, International Pharmaceutical Abstracts (IPA), Web of Science, and Academic Search Complete. RESULTS: Forty-one articles met the inclusion criteria and represent 32 unique collections of patient-pharmacist recordings. The 23 quantitative studies focused on "what" was in the interaction, whereas the 5 qualitative studies characterized specialized pharmacy practice and 13 studies used conversational analysis to describe "how" patients and pharmacists interact. The majority of research described the content of recorded interactions in community pharmacies. Twenty-three studies presented evidence of a biomedical model, whereas 8 studies characterized a patient-centered focus. CONCLUSIONS: A developing body of research used recordings to describe the content of patient-pharmacist communication and explore the quality of the interactions, validation of coding tools, impact of an intervention, and patient-pharmacist power asymmetry. Study findings, particularly the identification of biomedical vs. patient-centered communication, were guided by the quantitative, qualitative, or conversational analysis research paradigm.