“I just don’t want to take up people’s time” - A qualitative study exploring psychological safety during patient–healthcare provider conversations about medications

BACKGROUND: 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. METHODS: We conducted a qualitative study in Ontario, Canada, with adults taking at least one medication for ≥3 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 'Patient Belonging' (feeling accepted), 'Patient Learning' (feeling encouraged to ask questions), and 'Patient Participating' (feeling safe to share opinions), was used to guide a secondary deductive content analysis. RESULTS: Twenty-one individuals participated; most were ≥40 years old (n = 19), women (n = 14), and White (n = 14). Within 'Patient Belonging', participants described that feeling heard by HCPs supported perceptions of safety, whereas being dismissed contributed to mistrust. For 'Patient Learning', participants indicated 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 'Patient Participating', participants reported feeling empowered when invited to engage in medication-related decision-making, while perceived exclusion by HCPs led to frustration and disengagement. CONCLUSION: 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.