Discussing evidence with patients when prescribing

To facilitate shared decision making, prescribers need to guide patients through the risks and benefits of medicine use and be confident to explain the evidence-base underpinning different treatment options.
A clinician uses evidence to explain during a medical consultation

By the end of this article, you will be able to:

  • Understand the role of evidence-based practice in guiding safe and effective prescribing decisions;
  • Be aware of the need to identify and critically appraise key sources of evidence for their validity and relevance;
  • Communicate medication risks and benefits clearly to patients, using accessible language and supporting shared decision-making;
  • Recognise and manage common medication-related risks, including side effects and contraindications, through patient education and monitoring;
  • Document and reflect on prescribing decisions, incorporating ethical principles and a commitment to continuous professional development.

RPS Competency Framework for all Prescribers

This article is aimed to support the development of knowledge and skills related to the following competencies:

  • Domain 2.3: Assesses the risks and benefits to the patient of taking or not taking a medicine or treatment;
  • Domain 3.3: Explains the material risks and benefits, and rationale behind management options in a way the patient/carer understands, so that they can make an informed choice;
  • Domain 4.3: Understands and uses relevant national, regional and local frameworks for the use of medicines;
  • Domain 7.2: Knows about common types and causes of medication and prescribing errors and knows how to minimise their risk;
  • Domain 7.4: Recognises when safe prescribing processes are not in place and acts to minimise risks.

Introduction

The UK healthcare landscape is characterised by evolving pharmaceutical advancements, rigorous regulatory standards, and demands a vigilant and informed approach to prescribing practices​1–3​. In this dynamic environment, prescribing pharmacists are entrusted with the critical task of comprehending, communicating and appraising the evidence supporting prescribing decisions, as well as the associated risks.

This article aims to support improved understanding of evidence-based prescribing and risk. It highlights the pivotal role that pharmacist prescribers have in translating complex medical information for patients. 

It also explores important principles of evidence-based practice and risk communication. Through a comprehensive understanding of UK-specific medications, adept communication skills and a commitment to patient education, pharmacists can empower individuals to actively participate in decisions concerning their health.  

It is recommended that you read this article in conjunction with these resources from The Pharmaceutical Journal:

To help further expand your prescribing skills, additional related articles are linked throughout. You will also be able to test your knowledge by completing a short quiz at the end of the article.

Emergence and development of evidence-based practice

Both within the UK and globally, evidence-based practice has emerged in response to the ongoing need for, and the benefits derived from, a more rigorous approach to clinical decision-making and patient care. The use of medicines within healthcare is grounded in the application of the scientific method where a systematic approach is adopted to the acquisition of new knowledge through observation, experimentation and analysis​4​. This approach ensures that treatments and guidance are informed by a robust, reliable evidence base built on rigorous processes such as clinical trials, systematic reviews and peer review. Clinical trials — especially randomised controlled trials (RCTs) — are considered the gold standard in evaluating the efficacy and safety of medicines, as they provide controlled environments to assess outcomes in large populations. These trials are then subjected to peer review to ensure the validity, reliability and transparency of the findings​5​.  

In the UK, bodies such as the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare products Regulatory Agency (MHRA) play a central role in regulating and synthesising evidence to provide guidelines for healthcare practitioners. NICE publishes evidence-based guidelines to standardise care, ensuring that treatments are both clinically effective and cost-efficient​6​. This process, underpinned by continuous peer review and systematic evaluation, ensures that medication use is safe, effective and tailored to meet patient needs, providing the foundation for decision-making in healthcare practice. 

Pharmacist prescribers must integrate an evidence-based approach into their practice, stay informed about the latest research and apply it to patient care. They must ensure patients understand the evidence behind their treatment options to be able to make informed choices; however, evidence must also be critically assessed within the broader context of the patient’s unique circumstances. Prescribing pharmacists need to balance the application of evidence with patient preferences, comorbidities and individual responses to treatments, tailoring their advice to optimise patient outcomes​7​

Empowering patients to make informed decisions 

Person-centred practice recognises the importance of considering patient values, preferences and priorities when making prescribing decisions. Prescribers should look to facilitate shared decision-making with patients where treatment options are discussed jointly with the relative benefits and risks considered in relation to the patient’s individual circumstances and the impact on their overall quality of life​8​. Patient involvement has been shown to increase the likelihood an individual will remain adherent with the prescribed treatment and results in better outcomes​8​

However, several barriers can undermine patient empowerment and medication adherence. These include​9​:

  • Patient specific factors: particular to each individual and may include lack of knowledge and understanding about their condition or low levels of health literacy;
  • Illness specific factors: could include a lack of apparent symptoms resulting in the patient concluding they do not need to take medicines (e.g. an asthma patient who stops taking their inhaler daily because they have not had any recent exacerbations) or poor understanding of the progression of their illness (e.g. insidious or progressive diseases);
  • Medication specific factors: examples include lack of information about what the medicine does, side effects (or fear of them), complex regimes, polypharmacy or a lack of trust in the medicine prescribed (e.g. a generic substitution);
  • Health system barriers: such as poor communication, mistrust of professionals or paternalism, lack of support, structural health inequalities, poor access to care or pharmacy, multiple prescribers;
  • Diagnostic uncertainty and complexity: some patient presentations will involve symptoms that are challenging to differentiate or there may be multimorbidities and polypharmacy issues that add significant complexity for the patient; 
  • Social factors: including stigma, lack of support from family or carers, religious beliefs, use of alternative treatments (e.g. complementary therapies, herbal/traditional medicines, homeopathy);
  • Logistical factors: the ability to order and collect medicines, medicines shortages, renewal of medicines, lack of resource, cost etc.

While some of these factors may be beyond the control of an individual prescriber, it is possible to explore and overcome many of these barriers through careful discussion of risk and evidence that incorporates the patient’s ideas, concerns and expectations and results in a shared decision​10​.

The success of these discussions will be influenced by how well the prescriber is able to build trust and establish a therapeutic relationship. See ‘How to build and maintain trust with patients’ for more information. 

Box 1: When is shared decision making not appropriate? 

There are certain circumstances when a patient may be unable to make decisions over their own health, such as emergency situations where the patient isn’t conscious, as well as situations where patients lack mental capacity that also involves additional complexities. It is therefore sometimes necessary for healthcare professionals to make decisions that are in the patient’s best interest.

The Mental Capacity Act 2005 details a code of practice for people who work with and care for patients who cannot make decisions about treatment for themselves​11​. Decision-making will then require the involvement of family, carers or independent mental capacity advocates, as well as the clinicians involved. 

Providing information

Incorporating patient decision aids into consultations demonstrates pharmacists’ commitment to evidence-based practice and patient-centred care, enhancing the overall quality of pharmaceutical services​9​. In terms of information, there are now many different resources available in a variety of formats ranging from leaflets in different languages and braille to web-based patient decision aids, such as ‘Choice and Medication‘ for illnesses and treatments (see Further resources for a selection of examples). Written materials allow patients to review information at their own pace, summarising essential information about the medication, including risks, benefits and evidence​12​

When providing information, prescribers must tailor their approach to the individual ensuring that their communication approach aligns with the patient’s level of health literacy. Some patients may have low health literacy, requiring clear, simple explanations of their medication and treatment, while others, known as expert patients, will seek detailed knowledge about their condition and treatment options and it may be appropriate to direct them to medical journals, relevant sections of NICE guidance or the BNF​6,13​.

In addition to validated and approved sources, there are also many other places to find information. The reliability of information sources will vary and patients should be supported and encouraged to critically appraise materials about their condition that they may come across. For example, social media is now widely accepted as a primary form of communication and a resource that members of the public turn to for information and news, but it remains largely unregulated in terms of the quality and validity of information published or shared. Prescribers can help patients to better understand the nature of the information and provide simple structures for appraising online information. The patient’s association have produced some guidance that members of the public can follow, summarised in Box 2​14​.

Box 2: How patients can check the reliability of online information

Is there a date? 

As medical advice changes over time, patients should be encouraged to check the information accessed is up to date. Websites providing trusted health information will normally include a publication and review date. 

Who produced it? 

Knowing who produced the information can provide clues about why they produced it. For example, a commercial website or advertorial is likely to be promoting a product. While this does not necessarily make the information incorrect or untrustworthy, it should be factored in to the overall appraisal. 

What is the website address? 

Charity and non-profit websites often end in ‘.org.uk’ or ‘.org’. Government websites end in ‘gov.uk’. Academic institutions end in ‘ac.uk’.  

Does it look professional? 

Checking for things such as spelling errors, low-quality design and whether links work can provide further indications about the possible reliability of the information source. 

Is there evidence? 

Is the author expressing anecdotal information or an opinion based on their own experience? Do they cite evidence? 

Does it include sources?

If the author is claiming that the information is evidence-based, they should provide the sources to support this. 

Is it backed by other organisations? 

An endorsement or affiliation with a trusted organisation from a well-regulated sector can be a positive indicator that the source is likely to be reliable (for example, the NHS or a large charity). For further information, see ‘Finding trustworthy information online‘.

NICE guidance on medicines optimisation recommends the use of patient decision aids in consultations involving medicines​8​. This aligns with GPhC standards for pharmacists to communicate effectively and the requirement to maintain, develop and use professional knowledge and skills​1​.

With increasing availability of information resources, it is important to be prepared when planning a consultation by:

  • Finding information in different formats or languages, which is appropriate for different people who are older, younger or neurodiverse;
  • Ascertaining what they know about their condition and where they have looked for information already;
  • Arranging for a translator where available or asking a carer or family member along, provided this is agreed by the patient;
  • Making use of available patient decision aids;
  • Ensuring you are able to identify when patients may lack capacity and know how the Mental Capacity Act should be applied in these circumstances.

Discussing risk

In order to make informed choices about their treatment, it is vital that patients have a strong understanding of their health risk and how their use of prescribed medicines interacts with this. 

This requires prescribers to fully explain the potential risks and benefits of medications to patients compared with the status quo or alternatives. While this will be clear cut in many instances, there will also be complex cases — particularly when polypharmacy and multimorbidities feature — where the relative benefits of medicines use can be harder to judge. In these situations, it is necessary to consider a range of risk types and the nature of the underlying evidence and how well it translates to each patient. For example, clinical trial data and practice guidance tends to be generated with a focus on single conditions. Certain patient cohorts, such as pregnant women, frail older people and children, are also likely to be underrepresented in the trial data and evidence base, which can make individualised discussions of risk and benefits more challenging. It can also be helpful to consider some of the different statistical categories of risk and develop a suitable communication strategy to discuss this with patients (see Box 2​15–19​). 

Box 3: Statistic concepts of risk

  • Relative risk: What are the chances of the patients improving from the condition that is being treated if they do not have the drug in relation to the population in general?
  • Absolute risk to the patient: How does taking the drug reduce the patient’s condition/risk of dying?
  • Relative risk reduction: How much is the risk of dying from the condition that is being treated reduced in the group who are taking the drug compared with the percentage risk of dying because of the condition of the control group (those that have been included in the trial but not taken the drug)?
  • Numbers needed to treat: How many patients will need to be treated before the effects become evident?
  • Confidence intervals: A way of expressing the precision of an estimate or the uncertainty around it.

For more information on this topic, see ‘Communicating risk: how pharmacists should use data in conversations with patients’.

Consider the following case study, which explores some of these concepts within the context of a typical patient consultation.

Case in practice — use of evidence-based information in a prescribing scenario for cardiovascular disease 

Mr Smith, a 55-year-old man, attends a cardiovascular risk assessment clinic run by a prescribing pharmacist. Referred by his GP owing to concerns about his cardiovascular health, Mr Smith has a family history of cardiovascular disease (CVD), slightly elevated blood pressure and raised cholesterol levels.

During the consultation, the prescribing pharmacist conducts a QRISK3 assessment, which estimates his ten-year risk of developing CVD. The result indicates a 15% risk, placing him in the moderate-risk category.

After asking Mr Smith to describe his general health condition, the pharmacist assesses Mr Smith to have moderate health literacy. The pharmacist explains the QRISK score to Mr Smith, translating complex medical terms and statistical concepts into simpler language that he can understand. The pharmacist then provides important information on the benefits of lifestyle changes, including improving their diet and increasing exercise, as well as the possible need for statin therapy to lower cholesterol, explaining how a combination of changes can come together to reduce his overall risk of having a stroke or heart attack. The pharmacist also talks about the fact that the QRISK score does not factor in genetic variants and that it is important to also consider Mr Smith’s family history, which suggests an increased risk.

Mr Smith is keen to learn more about his condition and the pharmacist directs him to evidence-based resources, such as from the NHS and British Heart Foundation, where he can read more about how to manage cholesterol, QRISK scores and statins. The pharmacist also cautions him about the dangers of unreliable online information, explaining how some websites offer unverified or misleading advice, and instead recommends trusted sources such as NICE guidelines for more technical information.

Based on current NICE guidelines and working within their scope of practice, the prescribing pharmacist also discusses the potential benefits of initiating statin therapy for primary prevention of CVD. A shared decision is then taken, with Mr Smith agreeing to start on a statin so the pharmacist issues the prescription accordingly.

Outcome

Mr Smith feels empowered by the clear and targeted information. He starts on a low-dose statin, adopts a range of lifestyle changes and remains engaged with his healthcare journey. He regularly consults the NHS website for further advice and has started to experiment with changes to the types of food he eats, adopting a Mediterranean diet.

The pharmacist’s ability to assess his level of health literacy and provide a bespoke approach to the evidence-based information Mr Smith requires enabled him to make an informed choice about his treatment and become an active participant in the ongoing management of his health.

In this scenario, the pharmacist played a crucial role in bridging the gap between complex clinical data and the patient’s understanding of their disease risk, using evidence-based tools such as the QRISK score and trusted sources of information, combined with patient-specific factors to guide their approach to the management of their condition.

Ethical considerations when discussing evidence

There are also ethical considerations when discussing evidence with patients, such as:

  • Will explaining evidence and risk in a certain way influence a patient’s subsequent decision to accept a preventative treatment? 
  • Is this positive or negative?  
  • Should I be trying to change a patient’s mind or give my opinion on what course of action they should take? 

There may also be questions around the patient’s capacity to understand the information being provided and what is required for them to make an informed decision​20,21​. Pharmacists in clinical practice work with nurses, doctors and other medical professionals and — as medicines experts — are required to give advice on the latest medications and answer wide ranging medicines-related questions​1​. It is therefore appropriate to provide expert advice to patients when called upon, while respecting their individual preferences and working within the scope of practice and area of competence. The right to autonomy has primacy even if the patient’s decision may result in increased risk of harm or is contrary to public health priorities. 

Personal judgement will be required in these situations and the Medicines, Ethics and Practice (MEP), section 2.1.2 can provide helpful guidance​22​. Ethical issues often arise in situations where acting in the patient’s best interests may fall outside the legal constraints of normal practice​23,24​. It is entirely possible for two different pharmacists, faced with the same facts and circumstances, to choose two different courses of action.

In complex situations where clinical judgement is required, it is vital to remember that all pharmacist prescribers must only prescribe within their scope of practice and use professional codes as a guide. It would be difficult to defend your actions in a court of law or fitness-to-practice professional regulatory hearing if you could not demonstrate your expertise in a particular clinical area. 

Questions for reflection

  1. Next time you hold a patient consultation, consider how you might explain the benefits and risks of a prescribed medication. How could you improve the way you use evidence in those discussions?
  2. What strategies might you consider to support shared decision-making when the evidence base for a medication offers multiple treatment options or conflicting guidance exists?
  3. What are the potential consequences (positive or negative) of using evidence-based data (such as risk scores) when discussing medication with patients? How might you tailor this to individual health literacy levels?

Knowledge check

Further resources

The following resources expand on the information contained in this article:

  1. 1.
    Standards for pharmacy professionals . General Pharmaceutical Council . 2017. Accessed June 2025. https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_2017_0.pdf
  2. 2.
    A Competency Framework for All Prescribers. Royal Pharmaceutical Society. Accessed June 2025. https://www.rpharms.com/resources/frameworks/prescribing-competency-framework/competency-framework
  3. 3.
    Professional healthcare regulation in the UK explained. Professional Standards Authority for Health and Social Care. Accessed June 2025. https://www.professionalstandards.org.uk/news-and-updates/news/professional-healthcare-regulation-uk-explained
  4. 4.
    Trist DG. Scientific process, pharmacology and drug discovery. Current Opinion in Pharmacology. 2011;11(5):528-533. doi:10.1016/j.coph.2011.05.008
  5. 5.
    Evans D. Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing. 2002;12(1):77-84. doi:10.1046/j.1365-2702.2003.00662.x
  6. 6.
    Guidelines and standards. National Institute of Health and Care Excellence. 2021. Accessed June 2025. https://www.nice.org.uk/About/What-we-do/Our-Programmes/NICE-guidance/NICE-guidelines
  7. 7.
    Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71-72. doi:10.1136/bmj.312.7023.71
  8. 8.
    Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes NICE guideline . National Institute for Health and Care Excellence. Accessed June 2025. www.nice.org.uk/guidance/ng5
  9. 9.
    Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics. 2021;13(7):1100. doi:10.3390/pharmaceutics13071100
  10. 10.
    Elwyn G, Frosch D, Thomson R, et al. Shared Decision Making: A Model for Clinical Practice. J GEN INTERN MED. 2012;27(10):1361-1367. doi:10.1007/s11606-012-2077-6
  11. 11.
    Great Britain Department for Constitutional Affairs. Mental Capacity Act 2005 Code of Practice. Stationery Office; 2007.
  12. 12.
    Davis TC, Wolf MS, Bass PF, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006;21(8):847-851. doi:10.1111/j.1525-1497.2006.00529.x
  13. 13.
    Joint Formulary Committee. BNF. Accessed June 2025. https://bnf.nice.org.uk/about/joint-formulary-committee/
  14. 14.
    Finding trustworthy information online. Patients Association. Accessed June 2025. https://www.patients-association.org.uk/finding-trustworthy-information-online
  15. 15.
    Altman DG, Bland JM. Statistics notes: Absence of evidence is not evidence of absence. BMJ. 1995;311(7003):485-485. doi:10.1136/bmj.311.7003.485
  16. 16.
    Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. The Lancet. 2010;376(9754):1741-1750. doi:10.1016/s0140-6736(10)61543-7
  17. 17.
    Ferreira-González I, Permanyer-Miralda G, Busse JW, et al. Methodologic discussions for using and interpreting composite endpoints are limited, but still identify major concerns. Journal of Clinical Epidemiology. 2007;60(7):651-657. doi:10.1016/j.jclinepi.2006.10.020
  18. 18.
    Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995;310(6977):452-454. doi:10.1136/bmj.310.6977.452
  19. 19.
  20. 20.
    Duffy J. Informed consent: a year on from Montgomery. Medical Defence Union. 2024. Accessed June 2025. https://www.themdu.com/guidance-and-advice/guides/new-guidance-on-decision-making-and-consent
  21. 21.
    Montgomery and informed consent. Medical Defence Union. 2024. Accessed June 2025. https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent
  22. 22.
    Medicines, Ethics and Practice (MEP). Royal Pharmaceutical Society. Accessed June 2025. https://www.rpharms.com/publications/the-mep
  23. 23.
    Deans Z. The ethics of pharmacy practice: an empirical and philosophical  study. Pharmacy Practice Research Trust. 2010. Accessed June 2025. https://www.pharmacyresearchuk.org/wp-content/uploads/2012/11/Ethics_in_pharmacy_practice_200910.pdf
  24. 24.
    Orayj K, Alahmari K, Alasiri M. The Concept of Pharmacy Ethics and the Examples of Ethical Dilemmas Encountered by Pharmacists in the Asir Region, Saudi Arabia: A Qualitative Study. IJGM. 2022;Volume 15:4985-4996. doi:10.2147/ijgm.s368262
Last updated
Citation
The Pharmaceutical Journal, PJ, June 2025, Vol 314, No 7998;314(7998)::DOI:10.1211/PJ.2025.1.357748

    Please leave a comment 

    You might also be interested in…