{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T18:23:38Z","timestamp":1787250218035,"version":"build-2736575974"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016197","name":"Leslie Dan Faculty of Pharmacy, University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016197","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychologically safe environments, in which patients feel respected, able to ask questions, and comfortable raising concerns, are key aspects of person-centered care and overall quality of care. Examining the psychological aspect of managing medications remains underexplored despite its potential to improve patient safety and quality of care. To date, there is limited research on the perceptions of psychological safety among patients when discussing medications with their healthcare providers (HCPs). To address this gap, we explored perceptions of patient psychological safety during clinical encounters for medication management within primary and community care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study in Ontario, Canada, with adults taking at least one medication for \u22653 months. Participants were recruited through purposive, convenience, and snowball sampling. Semi-structured interviews and focus groups were held virtually between May and August 2024. The Patient Psychological Safety framework, which includes the constructs of \u2018Patient Belonging\u2019 (feeling accepted), \u2018Patient Learning\u2019 (feeling encouraged to ask questions), and \u2018Patient Participating\u2019 (feeling safe to share opinions), was used to guide a secondary deductive content analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-one individuals participated; most were \u226540 years old (n\u2009=\u200919), women (n\u2009=\u200914), and White (n\u2009=\u200914). Within \u2018Patient Belonging\u2019, participants described that feeling heard by HCPs supported perceptions of safety, whereas being dismissed contributed to mistrust. For \u2018Patient Learning\u2019, participants\u00a0indicated that clear and contextualized medication communication reduced anxiety and distress; in contrast, feeling overwhelmed, embarrassed or anxious during healthcare encounters acted as barriers to learning. For \u2018Patient Participating\u2019, participants reported feeling empowered when invited to engage in medication-related decision-making, while perceived exclusion by HCPs led to frustration and disengagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Psychological safety is integral to effective conversations about medications between patients and HCPs. Fostering environments in which patients feel heard, respected, and able to contribute to clinical decision-making may reduce distress and support engagement in medication treatment decisions. Future work should examine strategies to address multi-level barriers to promoting psychologically safe healthcare encounters around medications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356476","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T17:25:53Z","timestamp":1787246753000},"page":"e0356476","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cI just don\u2019t want to take up people\u2019s time\u201d - A qualitative study exploring psychological safety during patient\u2013healthcare provider conversations about medications"],"prefix":"10.1371","volume":"21","author":[{"given":"Rasha","family":"El-Kotob","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Cadel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6302-1496","authenticated-orcid":true,"given":"Jacob","family":"Crawshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saniyah","family":"Farzeen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7496-721X","authenticated-orcid":true,"given":"Aleena","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Dolovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9139-9250","authenticated-orcid":true,"given":"Sander L.","family":"Hitzig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Zidarov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal","family":"MacKay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie R.","family":"Cimino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Milligan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Lofters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9552-9139","authenticated-orcid":true,"given":"Sara J.T.","family":"Guilcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"pone.0356476.ref001","unstructured":"IQVIA Institute. The Global Use of Medicines 2024: Outlook to 2028. 2024. http:\/\/example.com"},{"key":"pone.0356476.ref002","unstructured":"World Health Organization. Patient Safety. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/patient-safety. 2023. Accessed 2025 August 19."},{"key":"pone.0356476.ref003","unstructured":"World Health Organization. Patient Engagement: Technical Series on Safer Primary Care. 2015 [cited 2026 Apr 30]. https:\/\/www.who.int\/publications\/i\/item\/patient-engagement"},{"key":"pone.0356476.ref004","doi-asserted-by":"crossref","first-page":"100491","DOI":"10.1016\/j.ssmqr.2024.100491","article-title":"Racial and ethnic differences in patient psychological safety: a qualitative patient narrative study","volume":"6","author":"C Rathert","year":"2024","journal-title":"SSM - Qualitative Research in Health"},{"issue":"8","key":"pone.0356476.ref005","doi-asserted-by":"crossref","first-page":"914","DOI":"10.3390\/healthcare13080914","article-title":"Barriers and facilitators to psychological safety during medical procedures among individuals diagnosed with chronic illness in childhood","volume":"13","author":"H Roche","year":"2025","journal-title":"Healthcare (Basel)"},{"issue":"3","key":"pone.0356476.ref006","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.pec.2008.11.015","article-title":"How does communication heal? 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Accessed 2026 May 9."},{"issue":"1","key":"pone.0356476.ref010","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.sapharm.2009.12.001","article-title":"Determinants of medication incident reporting, recovery, and learning in community pharmacies: a conceptual model","volume":"7","author":"TA Boyle","year":"2011","journal-title":"Res Social Adm Pharm"},{"issue":"4","key":"pone.0356476.ref011","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/2042098612444867","article-title":"High-risk prescribing and monitoring in primary care: how common is it, and how can it be improved?","volume":"3","author":"T Dreischulte","year":"2012","journal-title":"Ther Adv Drug Saf"},{"issue":"5","key":"pone.0356476.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0303107","article-title":"A shifting terrain: Understanding the perspectives of walk-in physicians on their roles amid worsening primary care access in Ontario, Canada","volume":"19","author":"BA Terpou","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0356476.ref013","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/jfmpc.jfmpc_837_19","article-title":"Patient safety in primary and outpatient health care","volume":"9","author":"R Kuriakose","year":"2020","journal-title":"J Family Med Prim Care"},{"issue":"10","key":"pone.0356476.ref014","doi-asserted-by":"crossref","first-page":"975","DOI":"10.3390\/jpm11100975","article-title":"Patients\u2019 characterization of medication, emotions, and incongruent perceptions around adherence","volume":"11","author":"P Tu","year":"2021","journal-title":"J Pers Med"},{"issue":"15","key":"pone.0356476.ref015","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.3390\/healthcare11152171","article-title":"Patient experiences of communication with healthcare professionals on their healthcare management around chronic respiratory diseases","volume":"11","author":"X Zhang","year":"2023","journal-title":"Healthcare (Basel)"},{"issue":"3","key":"pone.0356476.ref016","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1080\/02813432.2019.1639909","article-title":"Relationship based care - how general practice developed and why it is undermined within contemporary healthcare systems","volume":"37","author":"CE Rudebeck","year":"2019","journal-title":"Scand J Prim Health Care"},{"issue":"11","key":"pone.0356476.ref017","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1377\/hlthaff.2018.0716","article-title":"Patient engagement in health care safety: an overview of mixed-quality evidence","volume":"37","author":"AE Sharma","year":"2018","journal-title":"Health Aff (Millwood)"},{"issue":"15","key":"pone.0356476.ref018","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1001\/jama.286.15.1897","article-title":"Narrative medicine","volume":"286","author":"R Charon","year":"2001","journal-title":"JAMA"},{"key":"pone.0356476.ref019","unstructured":"Cadel L, El-Kotob R, Crawshaw J, McCarthy L, Dolovich L, Hitzig S. Exploring the use of patient-reported experience measures for medications in primary care in Ontario, Canada: A theory-based qualitative study. SSM \u2013 Health Systems."},{"issue":"45","key":"pone.0356476.ref020","article-title":"Post-positivism: an effective paradigm for social and educational research","volume":"45","author":"A Panhwar","year":"2017","journal-title":"International Research Journal of Arts and Humanities"},{"issue":"9","key":"pone.0356476.ref021","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research","volume":"89","author":"BC O\u2019Brien","year":"2014","journal-title":"Academic Medicine"},{"key":"pone.0356476.ref022","volume-title":"The 4 stages of psychological safety: Defining the path to inclusion and innovation","author":"TR Clark","year":"2020"},{"issue":"4","key":"pone.0356476.ref023","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1037\/tra0001313","article-title":"A new measure of feeling safe: Developing psychometric properties of the Neuroception of Psychological Safety Scale (NPSS)","volume":"16","author":"L Morton","year":"2024","journal-title":"Psychol Trauma"},{"issue":"1","key":"pone.0356476.ref024","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/15427609.2016.1141283","article-title":"The role of psychological safety in human development","volume":"13","author":"SB Wanless","year":"2016","journal-title":"Res Hum Dev"},{"key":"pone.0356476.ref025","volume-title":"Ontario demographic quarterly: highlights of second quarter","author":"Government of Ontario","year":"2024"},{"key":"pone.0356476.ref026","unstructured":"Government of Ontario. Get coverage for prescription drugs. Ontario, Canada. http:\/\/example.com. 2025. Accessed 2026 April 30."},{"key":"pone.0356476.ref027","article-title":"Exploring gaps in prescription drug insurance coverage among men and women in Canada using an intersectional lens","author":"FJ Yang","year":"2024","journal-title":"Insights on Canadian Society"},{"issue":"1","key":"pone.0356476.ref028","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the theoretical domains framework of behaviour change to investigate implementation problems","volume":"12","author":"L Atkins","year":"2017","journal-title":"Implementation Science"},{"key":"pone.0356476.ref029","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1748-5908-7-37","article-title":"Validation of the theoretical domains framework for use in behaviour change and implementation research","volume":"7","author":"J Cane","year":"2012","journal-title":"Implement Sci"},{"issue":"13","key":"pone.0356476.ref030","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies","volume":"26","author":"K Malterud","year":"2016","journal-title":"Qual Health Res"},{"issue":"1","key":"pone.0356476.ref031","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s13012-021-01111-5","article-title":"Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR)","volume":"16","author":"AL Nevedal","year":"2021","journal-title":"Implement Sci"},{"key":"pone.0356476.ref032","unstructured":"World Health Organization. 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