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Cognitive processes in pharmacists' clinical decision-making.

J F Mertens1, T G H Kempen2, E S Koster2

  • 1Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands.

Research in Social & Administrative Pharmacy : RSAP
|November 9, 2023
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Summary

Pharmacists utilize numerous cognitive processes for clinical decision-making in pharmacy practice. This study identifies 21 processes, highlighting the dynamic nature of their decision-making and informing educational models.

Keywords:
Clinical decision-makingClinical reasoningEducationPharmacistQualitative research

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Area of Science:

  • Pharmacy Practice
  • Cognitive Science
  • Healthcare Education

Background:

  • Clinical decision-making is central to pharmaceutical care.
  • Effective teaching methods for this process are not well-understood.

Purpose of the Study:

  • To investigate the cognitive processes pharmacists use in their clinical decision-making.
  • To explore how pharmacists perceive and teach clinical decision-making.

Main Methods:

  • Semi-structured interviews with 16 pharmacists across community, outpatient, and hospital settings.
  • Inductive thematic analysis of interview transcripts to identify cognitive processes.
  • Adaptation of a theoretical model to structure identified processes.

Main Results:

  • 21 distinct cognitive processes identified, organized into 8 steps of a clinical decision-making model.
  • Pharmacists found articulating their decision-making challenging, indicating a dynamic process.
  • Key steps include problem consideration, information gathering, clinical reasoning, judgment, shared decision-making, implementation, outcomes evaluation, and reflection.

Conclusions:

  • Pharmacists employ complex, dynamic cognitive processes in clinical decision-making.
  • The study provides a theoretical model for understanding and teaching clinical decision-making in pharmacy.
  • Enhanced understanding can improve pharmacy practice and education.