Factors influencing effective communication when prescribing

Introduction

Effective communication is an essential component of prescribing and vital to ensuring patient safety, shared decision making and optimal health outcomes​[1]​. Skilled communication is required to establish the needs of the patient and is a fundamental enabler for person-centred care. Interpersonal communication is influenced by many factors and it is important that prescribers develop an understanding of these factors and take proactive steps to optimise the conditions for each patient conversation, selecting an appropriate communication strategy.

This article will explore how to recognise these factors and provide practical examples to illustrate ways they can be accommodated during prescribing conversations. It is recommended that you read this article in conjunction with these resources from The Pharmaceutical Journal:

• ‘Principles of person-centred care for prescribing‘;
• ‘How to build and maintain trust with patients‘;
• ‘How to demonstrate empathy and compassion in a pharmacy setting‘.

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.

Improving health outcomes through effective communication

In the 2016 Marie Curie report ‘A long and winding road’, it is emphasised that individuals who possess confidence and effective communication skills play a crucial role in enabling and supporting patients, ultimately improving outcomes​[2]​. Example behaviours include:

• Encouraging patients to share information, fostering a climate of trust and openness;
• Providing patients with information that is clear and easily understandable, ensuring they have a comprehensive understanding of their healthcare;
• Motivating individuals to adhere to their medication regimen by highlighting the importance of taking medicines at the appropriate time and in the correct manner;
• Assisting patients in adopting healthier lifestyles, offering guidance and support in making positive lifestyle changes;
• Positively impacting a person’s mental state by promoting a supportive and empathetic environment, contributing to their overall wellbeing​[3]​.
  

Within the prescribing context, pharmacists can employ these actions to enhance healthcare outcomes and empower patients to make beneficial changes​[4]​. Prescribers should seek to continuously improve their communication skills and ability to appraise each patient encounter to identify the best communication approach to take. In providing person-centred care, it is important for prescribers to be aware of the factors that can influence the way prescribers and patients communicate. By identifying these factors from the macro and micro environment, a skilled communicator can adjust their approach and adapt their responses in the most effective way.

Macro influences on communication

Macro factors can influence the pharmacist prescriber’s capacity for effective communication. These factors are broad and can affect an entire organisation, region or country. Individual practitioners are unlikely to be able to change macro factors, but by being aware of their potential influence on communication, it becomes possible to modify and optimise their approach accordingly. For example, if a structural issue causing a medicine shortage is known and understood, prescribers can account for this when making plans with patients. The examples below explore a selection of macro influences within the healthcare context. Please note it is not an exhaustive list and you are encouraged to reflect on any additional macro influences that you are able to identify when reading through the examples.

Workforce

The composition and dynamics of the healthcare workforce can affect communication. With services frequently stretched, healthcare staff are required to work in pressurised environments, which can create barriers to effective communication. Interprofessional collaboration, effective teamwork and clear role delineation are essential for seamless communication and patient-centred care. A prescriber should be aware of the wider workforce context and how this may influence communication, particularly at points of transition. For example, medicines reconciliation when a patient moves from a secondary to primary care setting often becomes compromised owing to poor communication between clinicians; often, this is a consequence of how services and teams are structured.

Policy and legal frameworks

Policies and legal regulations (see Table) shape the prescribing process and may introduce certain requirements affecting communication​[5]​. Regulations set parameters over what the prescriber is allowed to do and introduce accountabilities and obligations that need to be followed. For example, there are clear rules governing patient consent, documentation and record keeping. These factors can include restrictions on prescribing certain medications (e.g. Misuse of Drugs Act), requirements for documentation (e.g. Access to Health Records Act), and privacy regulations (e.g. GDPR). Pharmacists must be knowledgeable about the relevant policies and communicate them effectively to patients, as required, while maintaining confidentiality.

Clinical setting and service design

Factors such as background noise and lighting, or the frequency of interruptions, can impede effective dialogue between the prescriber and patient and, in many cases, this will be connected to the way services are designed and delivered. For instance, a busy community pharmacy may experience high patient volumes, limiting the time available for thorough communication. Similarly, a clinic-based pharmacist will be affected by the time constraints of the appointment and the need to balance complex needs of individual patients with their obligation to effectively manage and support their wider patient cohorts. Considerations for effective communication in a clinic setting have been covered in a previous article. Prescribers should be conscious of the specific characteristics of the setting they work in and consider how this may influence their interactions with patients.

Demographics, cultural and language factors

Culture and language play a significant role in patient communication​[6]​. Cultural competence is essential for understanding and respecting patients’ beliefs, values and practices, and for delivering person-centred practice. Effective communication requires sensitivity to differences between groups, including language barriers, health beliefs and communication norms. For example, in a multicultural pharmacy setting, pharmacists must employ interpreters or utilise translated materials to ensure effective communication with non-native speakers. Developing your knowledge of local demographics and the different communities and patient groups accessing healthcare services will improve your ability to identify specific needs and communicate effectively.  

Organisational culture

There is a well-documented link between organisational culture and patient safety​[7]​. The report on the Mid Staffordshire NHS Foundation Trust Public Inquiry illustrated how severe the consequences can be when staff values and behaviours are allowed to become harmful​[8]​. It is vital that every level of the health service works towards the creation of a compassionate and inclusive culture.

Societal change

Broader social and cultural change will also influence communication when prescribing. For example, consider how public expectations of healthcare are changing with patients expecting high standards of care, more information about their treatments and greater involvement in decisions. Similarly, developing technology continues to introduce new mediums of healthcare communication and changes the way healthcare information can be shared and accessed.

Micro influences on communication

In addition to macro influences, there are also many micro influences that affect communication between a prescriber and a patient. These will be unique to each patient encounter and a skilled prescriber taking a person-centred approach should seek to positively affect these influences and set optimal conditions for effective communication. The following examples explore some of these micro influences.

Clinical competence

Prescribers must possess a comprehensive understanding of medications, indications, contraindications and potential side effects​[9]​. By leveraging their clinical competence, prescribers can establish a solid foundation of trust, enhance patient understanding and support informed decision making, ultimately leading to improved patient outcomes. Improving a prescriber’s clinical competence increases their capacity to communicate effectively. Conversely, if a prescriber has low clinical competence or is operating beyond their scope of practice, their ability to communicate effectively will be negatively affected.

Interpersonal skills and communication techniques

Strong interpersonal skills and the ability to utilise different communication styles and techniques is essential. Pharmacists should be aware of their body language and non-verbal cues, and develop their questioning skills to create a comfortable and open environment for patients to express their health concerns and describe their symptoms. Active listening, empathy and clear explanations of treatment options are essential components of effective communication. For example, motivational interviewing (MI) has proven to be an effective approach in enhancing patient motivation for behaviour change across a range of health issues influenced by behaviour. Additionally, MI has demonstrated its value in promoting treatment adherence and optimising medical interventions. By employing MI techniques, healthcare professionals can effectively support patients in their journey towards positive behaviour change, leading to improved health outcomes and increased treatment compliance​[10]​.

Views and beliefs of the patient and prescriber

The lived experience of both the patient and prescriber contribute to opinions, beliefs and bias that will influence communication. For example, some patients may hold a paternalistic view of healthcare, while others may lack trust in the healthcare system or question the expertise of the prescriber. Identifying relevant views and beliefs is an important initial step in establishing effective communication.

Physical and emotional factors

Communication can be influenced by how the patient and prescriber are feeling at the time of the interaction. The patient’s health condition or symptoms could affect their ability to contribute to a dialogue or they could be experiencing a mental health condition, such as depression or anxiety. Diet and hydration levels can also influence how individuals engage in conversation.

Patient/clinician relationship and power imbalance

The power dynamic within the patient–clinician relationship can also impact communication. Power imbalances can exist owing to the perceived authority of the prescriber and a possible lack of agency for the patient, potentially inhibiting open and honest dialogue. Building a therapeutic relationship based on trust, respect and shared decision making helps mitigate these imbalances and enhances communication​[11]​.

The following scenario explores some these factors in practice.

Strategies for creating a constructive environment for communication

Once specific influences and dynamics that may affect the prescribing conversation have been identified, it becomes possible to make adjustments that optimise the interaction. The prescriber should be conscious of both the macro and micro influences and seek to tailor their approach to fit the needs of the specific encounter. The following examples include ways in which this can be achieved.

Establishing a welcoming environment

In a pharmacy setting, creating an environment that promotes open communication is crucial. For instance, in a community pharmacy, this could include displaying culturally-diverse resources, such as brochures and pamphlets that address common health concerns in different languages or that are directed towards different patient groups and communities (e.g. the LGBTQ+ community or men).

Enhancing language access

Language barriers can impede effective communication when prescribing medications and supporting patients to maintain adherence​[12,13]​. To overcome this, pharmacists can utilise professional interpreters or translation services to facilitate accurate and clear communication with patients who have limited English proficiency. Visual aids, diagrams and written instructions can also be used to supplement verbal communication, enhancing understanding and reducing the risk of miscommunication. If professional interpreters are not available, it may be possible to find creative solutions to overcome language barriers, including use of technology (e.g. Google translate) or the involvement of family members.

Prioritising patient education

With appropriate information and support, patients can develop an understanding of their individual health and condition, and be empowered to make more informed choices about their treatment and lifestyle​[14,15]​. Pharmacists should develop patient education materials that are clear, concise and tailored to individual patient needs. Medical language and terminology can present barriers to communication, which can be accommodated by providing explanations that align with the patient’s level of knowledge about their condition and general level of health literacy. By explaining medication instructions verbally and reinforcing them with written materials, pharmacists can improve patient comprehension and ensure they have a clear understanding of how to take their medications. Furthermore, effective communication becomes important in instances where medication is not prescribed, such as acutely-presenting minor ailments, including coughs and colds. Patients often assume the need for antibiotics; in such cases, pharmacists can clearly explain how the condition can be well managed without a prescription, emphasising the importance and benefits of non-pharmacological approaches.

Practicing empathic care

Empathy plays a crucial role in establishing a therapeutic relationship​[16]​. Clinicians can empathise with patients by understanding their emotions and experiences without taking those feelings upon themselves. They can relate to the patient’s world but should be able to extricate themselves from it. It is important to distinguish empathy from sympathy. Empathy can be deployed while maintaining professional objectivity and logical decision making, whereas sympathy can compromise ethical decision making owing to its inherent emotional subjectivity and the potential for this to hinder a clinician’s ability to effectively help and maintain professional boundaries​[17]​. Demonstrating empathy during the initial stages of a consultation can help to validate patients’ concerns and emotions, creating a supportive environment where patients feel heard and understood. This creates a platform for enhanced communication and contributes to improved patient satisfaction.

Knowledge check