An exploration of attitudes and preferences towards medications among healthcare providers and persons with spinal cord injury/dysfunction: a qualitative comparison

Abstract

Purpose

To compare the attitudes and preferences of persons with spinal cord injury/dysfunction (SCI/D) and healthcare providers regarding prescription medications, over-the-counter medications, and natural health products (NHPs).

Materials and methods

A qualitative study involving semi-structured interviews with healthcare providers (n = 32) and persons with SCI/D (n = 19) in Canada. Inductive descriptive and interpretive analyses were conducted using data display matrices and a constant comparative approach.

Results

Participants described differing perceptions of therapeutic benefits based on medication type, with shared attitudes about the therapeutic benefits of prescription medications and differing views about the effectiveness of NHPs. Despite the perceived effectiveness of prescription medications, persons with SCI/D preferred to avoid them due to concerns about side effects, safety, and stigma. Persons with SCI/D were often concerned about the long-term safety of prescription medications, whereas providers focused more on medication-related addictions. Participants discussed stigma relating to prescription medications, NHPs, and medicinal marijuana.

Conclusion

Healthcare providers and persons with SCI/D described different attitudes about and preferences for pharmacotherapeutic products, contributing to challenges in optimizing medication management. Strategies to improve medication management include shared decision-making to incorporate patient preferences into care plans and explicit discussions about long-term medication safety. Further, steps are needed to combat the stigma associated with medication use.

Implications for rehabilitation

• Following a person-centered approach to shared decision-making, prescribers should initiate explicit conversations about patient medication preferences, short and long-term prescription medication side effects, and alternative treatment options.

• Regarding prescription medication safety, persons with spinal cord injury/dysfunction focused on the long term impact of medications, while providers focused on medication-related addictions, highlighting a disconnect that should be discussed during initiation, continuation, or discontinuation of a medication.

• Providers should be mindful of the stigma associated with taking multiple prescription medications, including medicinal marijuana, as well as the stigma associated with over-the-counter medications and natural health products.

• Providers could benefit from education about spinal cord injury/dysfunction-specific prescription medications and could benefit from increased education about natural health products.

Keywords:

• Patient attitudes and preferences
• prescription medications
• natural health products
• medication management
• health personnel
• shared decision-making

Acknowledgements

The authors would like to acknowledge the Ontario Pharmacy Evidence Network (OPEN) for supplying a database from which Ontario pharmacists were recruited and Spinal Cord Injury Ontario for assisting with recruitment of persons with SCI/D. The authors would also like to thank Maliha Asif for assistance with the literature review.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

To protect participant confidentiality and to fulfill our ethical requirements, datasets for this study will not be made available.

Additional information

Funding

This work was supported by the Craig H. Neilsen Foundation (Psychosocial Research Pilot Grant #441259); the Connaught New Investigator Award (University of Toronto); and the Graduate Department of Pharmaceutical Sciences at the University of Toronto (Dean’s Fund; Clinical, Social & Administrative Pharmacy Professors’ Award for Thesis Research; and Pfizer Canada Fellowship in Health Outcomes Research). Dr. Guilcher is supported by a Canadian Institutes of Health Research Embedded Clinician Scientist Salary Award on Transitions in Care (2016–2020) working with Ontario Health (Quality, formerly Health Quality Ontario).