Understanding Patient Medication Experiences through Theater

by Alexandra Frazier, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Cernasev A, Kuftinec S, Bortz R, Schommer JC, Ranelli PL. Using Theater as an Educational Tool for Understanding Medication Experiences from the Patient Perspective [Internet]. Am J of Pharm Educ. 2020; 84(4): Article 7606. doi:10.5688/ajpe7606

As student pharmacists, a great deal of our education is dedicated to learning how to provide medication counseling and handle patient interactions in various pharmacy practice settings. This training not only involves learning how to provide the essential information patients need to use medications wisely but also delivering that information with empathy, listening actively to patients, and applying motivational interviewing techniques. Though pharmacy students are trained on how to assist patients struggling to acquire medications, students in other healthcare professions do not always receive formal instruction about how to assist patients experiencing access barriers. Healthcare professionals should be knowledgeable about the issues that may arise when medications are prescribed to patients, be prepared to handle these situations efficiently, and be able to express empathy for patients in difficult situations.

This unique study examined the effectiveness of theater as an educational tool for healthcare professionals.¹ The American Alliance for Theatre and Education (AATE) defines drama-based learning strategies as “an improvisational, non-exhibitional, process-centered form of drama in which participants are guided by a leader to imagine, enact, and reflect upon human experiences.”² I was captivated by this study because it allowed healthcare practitioners to gain perspective into patients’ experiences in an innovative way.¹

From April 2015 to March 2016, adults in the U.S. completed the self-administered the National Consumer Surveys on the Medication Experience and Pharmacist Roles. Comments from this survey were compiled detailing participants’ medication experiences. These comments were then used as the inspiration for a theatrical script written by Syl Jones and performed by Mixed Blood Theatre. The play, Go Ask Alice, included a total of seven scenes that explored multiple patient scenarios as well as a mock drug advertisement. There were two performances of Go Ask Alice – one in Minneapolis, Minnesota on November 29, 2016, and the other in Duluth, Minnesota on November 30, 2019. The play lasted ~60 minutes and was followed by a talk-back session facilitated by one of the authors that lasted ~30 minutes. These talk-back sessions were not led by any guided questions but instead allowed audience members to discuss the play openly with one another. Members of the audience were asked to complete a survey before the performance, immediately after the talk-back session, and then three weeks later. These assessments each contained the same seven statements regarding patient medication experiences and asked participants to rate their agreement with each statement. The two additional questionnaires were administered after the play which contained demographic questions and open-ended questions asking for feedback on the experience. The findings from the seven statements were summarized with descriptive statistics and inductive thematic analysis was performed on the open-ended questions.¹

A total of 225 health professions students attended the two performances; 161 participants completed the post-performance survey and only 58 completed the 3-month follow-up survey. There was a significant increase in the survey scores before vs. after the performance. Some of the key results of this survey are detailed in Table 1. During the qualitative analysis, the responses to the open-ended questions were merged into six categories then ultimately two themes: 1) barriers faced by patients when seeking health care services and 2) major hindrances and contributors to the patients’ medication experience. Overall, the results show that theatrical performance may be an effective educational tool to understand the human experience from a patient’s perspective.¹

Table 1: Pre- and Post-Performance Survey Results

Survey Item	Before Performance, Mean (SD)	After Performance, Mean (SD)	P-value
I am able to fully empathize with patients	3.6 (0.9)	3.9 (0.9)	<.001
I am fully aware of all the challenges patients experience with taking their medications	3.0 (1.1)	3.4 (1.1)	<.001
I am fully aware of the attitudes patients hold toward their medications	2.8 (0.9)	3.5 (1.0)	<.001
I am fully aware of all the challenges patients experience with filling their medications	3.0 (1.0)	3.6 (1.1)	<.001
I am fully aware of the roles of medications in society	3.3 (0.9)	3.6 (0.9)	<.001
I fully understand the process of prior authorizations	2.9 (1.2)	3.5 (1.1)	<.001
I fully understand the effect of the medication experience on a patient’s family	2.9 (0.9)	3.5 (1.1)	<.001

 

One of the biggest strengths of this study is the longitudinal assessment of audience members’ perspectives before and after the performance as well as three months following the play. This was an effective way to discern the audience’s initial perceptions and how Go Ask Alice affected their understanding of patients’ medication experiences. The post-performance talk-back session could be seen as both an advantage and disadvantage. The session allowed audience members to explore their feelings and reactions to the play, which would be advantageous for learners. However, this discussion could have influenced the results of the surveys by emphasizing all the aspects of patient experience that audience members were supposed to get from the play but did not. Another disadvantage of this study is the cost and access! The two performances cost roughly 25000.  Only 225 were in attendance and the two plays were held in a relatively small geographical area (both in Minnesota). Because of this, Go Ask Alice was not widely available. A wider audience (from different geographic areas) may not have the same of reaction to the play. There was also some concern from the audience that too much medical jargon was used in the script.

I feel like the analysis method used to evaluate the rate of agreement with the seven statements was appropriate, as was the use of a thematic analysis for the evaluation of the open-ended questions. For this qualitative analysis, one researcher read the comments several times and identified the main codes and categories. After this, a second researcher evaluated the codes and categories.  If needed, the second researcher debated the coding and classifications with the first researcher.  Based on both the results of this study and my personal experience with drama-based educational techniques, I do believe theater is an effective way to teach healthcare providers to see experiences from patients’ perspective. Moreover, this is an entertaining way to present information when real-life experience may not be a practical option.

Another study explored the negative impact of medication-related burden (MRB) and patients’ lived experience with medication (PLEM) therapies or medical conditions.³ This study concluded that because of the impact MRB has on patients’ beliefs and behaviors toward medications, healthcare practitioners need to have better insights into PLEM to improve patients’ medication therapy and outcomes.³ Though theatre models have been used to educate healthcare students in various situations, there is little literature on the appeal of such techniques to trainees.⁴ Another study concluded that the drama-based learning technique used had a generally positive influence on medical students’ perceptions.⁴

Because patient-centered care has the potential to strongly impact patient health outcomes, healthcare providers need to understand the struggles patients might face and be able to express empathy.⁵ This study explored an innovative teaching method that allowed audience members to understand and experience medication issues from a patient perspective.¹ Based on the feedback received from the audience, it seems that the educational tool was successful in achieve its goal but it’s impact was limited to a small audience.¹ In the future, such plays could be recorded for mass viewing or even adapted into active learning exercises for re-enactment by students in the health professions. Future healthcare professionals may benefit from the incorporation of drama-based learning strategies into their curricula, especially in areas where understanding the patient’s perspective is critically important.

References:

1. Cernasev A, Kuftinec S, Bortz R, Schommer JC, Ranelli PL. Using Theater as an Educational Tool for Understanding Medication Experiences from the Patient Perspective [Internet]. Am J of Pharm Educ. 2020; 84(4): Article 7606.
2. DBI Network: Activating learning through the arts [Internet]. Austin: The University of Texas at Austin; c2020. Drama-based Pedagogy; 2020. Available from: https://dbp.theatredance.utexas.edu/about
3. Mohammed MA, Moles RJ, Chen TF. Medication-related burden and patients’ lived experience with medicine: a systematic review and metasynthesis of qualitative studies [Internet]. BMJ Open. 2016; 6: e010035. doi: 10.1136/bmjopen-2015-010035
4. Keskinis C, Bafitis V, Karailidou P, Pagonidou C, Pantelidis P, Rampotas A, Sideris M, Tsoulfas G, Stakos D. The use of theatre in medical education in the emergency cases school: an appealing and widely accessible way of learning [Internet]. Perspect Med Educ. 2017; 6: 199-204.
5. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J. The Impact of Patient-Centered Care on Outcomes [Internet]. J of Fam Prac. 2000; 49(9): 796-804.