Transcript Assessment of Student Pharmacists` Ethical Decision Making

Assessment of Student Pharmacists’ Ethical Decision Making
Jaclyn Myers, Pharm.D. Student and Kimberly S. Plake, Ph.D., R.Ph.
Purdue University, West Lafayette, Indiana
Rationale
Results
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As healthcare professionals, pharmacists regularly face ethical situations in practice.
●
With an increased focus on clinical functions, it is important to understand how student
pharmacists, as future practitioners, will respond to ethical dilemmas.
●
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In some previous studies, it has been shown that pharmacy students may not be as morally
developed as students in other health professions.1,2
Therefore, further exploration of pharmacy student’s perceptions of specific ethical situations
pertinent to pharmacy is warranted to target educational interventions that may foster ethical
development of future pharmacy professionals.
Study Objectives: To examine student pharmacists’: 1) attitudes and responses to ethical
situations, and 2) level of difficulty in making ethical decisions.
●
A paper survey previously administered to practicing pharmacists was adapted for administration
to student pharmacists.
The survey consisted of 37 item in four sections:
►Attitudes towards common ethical situations (10 items)
►Responses to specific ethical scenarios (8 items)
►Perceived level of difficulty in resolving ethical dilemmas (9 items)
►Demographics (10 items)
●
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Statement
Pharmacists have the right to
refuse to dispense a
prescription based on clinical
reasons.
Pharmacists have the right to
refuse to dispense a
prescription based on moral
or religious reasons.
Results
Respondents’ Demographics (N=236)
Variable
%
Gender
Female
65.7
77.1
Marital Status
Single
Catholic
30.1
Protestant
19.1
Non-denominational
17.8
233
14.4%
16.5%
2.5%
21.6%
41.5%
2.1%
42.4%
18.6%
19.1%
28.4%
16.1%
52.5%
16.9%
5.5%
17.8%
19.1%
3.4%
Emergency contraceptive
(EC) should be available by
prescription only.†
236
33.5%
39.8%
13.6%
8.5%
4.7%
Schedule V codeine cough
syrup should be available by
prescription only
236
8.5%
30.5%
21.6%
29.7%
9.7%
p<0.05 for gender,
for professional year,
✪p<0.05
for religious background,
†p<0.05
You receive a prescription for a
lethal dose of a narcotic for a
patient that has been terminally
ill for quite sometime. You
would dispense the medication.
A young adult male comes into
the pharmacy and requests EC
(Plan B) for his girlfriend. You
know that both the male and
his girlfriend are 18. You
would dispense the medication.
*
N
236
236
235
Strongly
Strongly
Disagree Undecided Agree
Disagree
Agree
25.8%
22.9%
5.5%
36.4%
40.3%
9.3%
20.8%
19.1%
6.4%
14.0%
16.1%
45.8%
3.0%
1.7%
32.6%
Agree
Strongly
Agree
Albuterol Aerosol
235
2.5%
7.2%
6.8%
38.6%
44.5%
Crestor
235
4.7%
14.0%
10.6%
44.5%
25.8%
Dilantin
234
5.1%
12.7%
20.3%
33.9%
27.1%
Vicodin*
235
33.1%
38.6%
21.6%
5.5%
0.8%
Imitrex
234
5.1%
17.8%
22.5%
41.9%
11.9%
Lexapro*
235
3.4%
14.8%
17.8%
43.6%
19.9%
Plavix*
233
3.4%
8.9%
7.2%
49.2%
98.7%
Viagra†
233
39.4%
35.2%
9.3%
9.3%
5.5%
p<0.05 for gender, p<0.05 for professional year, ✪p<0.05 for religious background, †p<0.05 for political
affiliation
*
Student Pharmacists’ Perceived Difficulty
in Making Ethical Decisions
Decision is problematic
Statement
N
Whether to fill an
inappropriate prescription
that is essentially unharmful
but will not benefit the
patient when another
medication would.†
233
8.9%
33.5%
36.4%
14.8%
5.1%
Whether to provide/
dispense medications that
are against your religious
beliefs.✪†
235
8.9%
11.9%
21.6%
20.3%
36.9%
Whether to dispense
addictive medications in the
case of suspected or
developing abuse.
234
14.0%
44.1%
30.5%
7.6%
3.0%
Whether to withhold
information from a patient
because of a physician’s
request.*
232
16.1%
28.0%
31.8%
16.1%
6.4%
Whether to sell ineffective
but heavily promoted OTC
products.*†
235
9.3%
20.8%
39.4%
23.7%
6.4%
for political affiliation
Student Pharmacists’ Attitudes Toward Various Ethical Situations
Statement
N
Strongly
Disagree Undecided
Disagree
Very
Moderately Somewhat Rarely
Not
p<0.05 for gender, p<0.05 for professional year, ✪p<0.05 for religious background, †p<0.05 for political
affiliation
*
p<0.05 for gender, p<0.05 for professional year, ✪p<0.05 for religious background, †p<0.05 for political affiliation
Primary Practice Site
85.6
Age
18-24 years
%
Religious Background
Racial Background
Caucasian
Variable
236
0.4%
44.5%
A patient hands you a
prescription for Nexium®,
which was written by a local
dentist. You would dispense
the medication.
rate was 73.8% ( 236 respondents out of 320 valid surveys)
236
14.4%
p<0.05
Late on Friday evening, a patient explains how he/she left his/her medication at
home and is on vacation for a week. His/ Her regular pharmacy and doctors are
unavailable. You would lend the medication for…
Statement
234
*
Second and third professional year student pharmacists at Purdue University West Lafayette
were recruited (potential N=320). Students were informed of the opportunity to participate and
copies of the survey were distributed in courses at the conclusion of the class period.
Strongly
Strongly
Disagree Undecided Agree
Disagree
Agree
Syringes should be available
by prescription only.*
A Likert Scale (1=strongly agree and 5= strongly disagree) was utilized to assess level of
agreement with each statement or case. In the third section, a scale (1= very problematic and 5=
not problematic) was adapted from Haddad to used to determine degree of difficulty.
●Response
N
Pseudoephedrine should be
available by prescription only.
Methods
●
Student Pharmacists’ Willingness to Dispense
Student Pharmacists’ Attitudes Regarding Ethical Issues in Practice
Community
Hospital
83.1
Political Affiliation
Multiple
Other
Discussion and Conclusions
68.6
7.6
21.2
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A majority of student pharmacists believe that pharmacists have the right to refuse dispensing based on clinical reasons, but opinions are much more widely varied in terms of
refusing dispensing based on moral or religious reasons.
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Student pharmacists disagree that emergency contraceptive should be available prescription only.
2.5
Republican
44.5
Length of Practice
Democrats
24.6
4 or more years
33.1
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Student pharmacists are most willing to dispense Plavix and least willing to dispense Viagra and Vicodin without a prescription.
Independent
23.7
3 years
25.0
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Student pharmacists find it most difficult to make decisions regarding suspected abuse and least difficult to make dispensing decisions that are against their religious beliefs.
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Next steps of the analysis include inclusion of first professional year data and the comparison of ethical decisions to the perceived difficulty in making that decision.