Psychosocial factors associated with pharmacists’ end-of life medication counseling and dispensing

Abstract Objective In 2015, California legalized physician-assisted suicide through passing the End-of-Life and Options Act (ELOA) which gives terminally-ill patients more control over their death. Little is known about the best psychosocial predictors and precedents of pharmacists' willingness to participate in physician assisted suicide and the main drivers of pharmacists' dispensing of aid-in-dying drugs. The study aimed to identify and describe the psychosocial factors associated with pharmacists' intention to counsel and dispense end-of life medications. Design Cross-sectional study based on the Theory of Planned Behavior (TPB). Setting and participants: Community pharmacists practicing in California. Outcome measures 2,000 pharmacists were surveyed using a cross-sectional, 51-item mail survey instrument. Study collected data on TPB constructs (attitude, subjective norm [SN], perceived behavioral control [PBC]), behavioral and control beliefs, perceived obligation, and demographic and practice characteristics data. Hierarchical linear regression was used to identify the factors associated with pharmacists' intention. Results A total of 353 responses (19.4% response rate) were received from respondents with an average age of 50.4±14.8 years. A majority of the respondents were female (53.1%) and religious (56.4%). Most pharmacies did not currently stock the ELOA medication (n = 197, 56.1) and most pharmacists had never been presented with an ELOA prescription in their practices (n=319, 90.4%). Pharmacists had a positive intention (mean=8.24±4.6, range: 2-14), attitude (mean=17.15±6.9, range: 4-28), subjective norm (mean=1.1±4.5; range: -9-+9) and PBC (mean=1.85±3.5; range: -6-+6) to dispense ELOA medication. Attitude (β=0.570, p Conclusion Interventions to promote pharmacists' counseling and dispensing of ELOA medication should focus on developing strong intention. Increasing pharmacists' attitude, subjective norm, and perceived obligation is critical to increasing pharmacists' willingness to dispense the ELOA medication.