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Association between functional assertiveness and stress related to deprescribing recommendations among community

Mitsuaki Ishii^1,2, Sachiko Ozone², Shoichi Masumoto²

¹Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo-shi, Hokkaido 006-8585, Japan.

Exploratory Research in Clinical and Social Pharmacy

|April 21, 2026

Abstract

Background:

Polypharmacy is an important challenge in an aging society, and pharmacists recommending deprescribing is beneficial from a patient safety perspective. However, this process often creates interprofessional communication challenges between pharmacists and physicians, leading to stress for community pharmacists. Assertiveness, defined as expressing oneself openly while respecting others, is an educable skill for managing work-related stress in healthcare settings and is considered a stress-coping factor. However, its specific effect on the stress related to deprescribing remains unclear.

Objective:

This study aimed to investigate stress levels related to deprescribing recommendations among community pharmacists and examine their relationship with the level of assertiveness.

Methods:

A cross-sectional survey was conducted among community pharmacists between May and October 2022. Participants were community pharmacists belonging to two pharmacy chains in Japan. The primary outcome variable was stress related to deprescribing recommendations, which was used to categorize respondents into high-stress (Visual Analog Scale [VAS] ≥ 70) and low-stress (VAS < 70) groups. The primary explanatory variable was the Functional Assertiveness Scale (FAS) total score, and respondents were dichotomized based on the median score. Pharmacist characteristics were compared by stress group in univariate analyses. A Generalized Linear Model with a binomial distribution was used to examine the association between FAS score and the likelihood of low stress, adjusting for confounding factors including demographics and organizational variables.

Results:

A total of 415 pharmacists were included in the final analysis and 40.2% were classified into the high-stress group. In the adjusted multivariate model, high functional assertiveness was significantly positive associated with reporting low stress (odds ratio, 2.62; 95% confidence interval, 1.66-4.14; p < 0.01).

Conclusion:

Higher functional assertiveness among community pharmacists is associated with lower stress related to recommending deprescribing.

Keywords:

Assertiveness Community pharmacist Deprescribing recommendation Stress coping

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