Psychological safety is a core component of person-centered care and relates to patients feeling able to voice concerns, ask questions, and express opinions without fear of negative consequences. In the context of medication management, psychological safety may improve communication about medications and help patients raise concerns or report errors. The World Health Organization has highlighted person-centered medication management and medication safety as global priorities. Despite this, the psychological dimensions of medication management remain underexplored, particularly in primary and community care where medication decisions are longitudinal, distributed across multiple providers, and often self-managed by patients.
The Patient Psychological Safety (PPS) framework characterizes patient experiences of psychological safety using three constructs: Patient Belonging (feeling accepted and heard), Patient Learning (feeling encouraged to ask questions and understand care), and Patient Participating (feeling safe to share opinions and take part in decisions). The authors applied this framework to examine how adults perceive psychological safety during medication-related clinical encounters in primary and community care settings.
The study used a qualitative design conducted in Ontario, Canada, with adults who had been taking at least one medication for three months or longer. Participants were recruited through purposive, convenience, and snowball sampling. Data were collected via semi-structured interviews and focus groups held virtually between May and August 2024.
A secondary deductive content analysis was guided by the Patient Psychological Safety framework, mapping participant accounts onto the three PPS constructs: Patient Belonging, Patient Learning, and Patient Participating. The study adhered to ethical requirements; the manuscript reports that additional identifiable raw data cannot be shared publicly due to participant consent and University of Toronto research ethics restrictions.
Twenty-one individuals participated. The sample was predominantly aged 40 years or older (n = 19), mostly women (n = 14), and primarily White (n = 14).
Patient Belonging
Participants reported that feeling heard and respected by healthcare providers supported perceptions of safety. When HCPs listened attentively and acknowledged patient concerns, patients felt accepted and more comfortable discussing medication issues. Conversely, experiences of being dismissed or judged by providers contributed to mistrust and reluctance to raise medication-related concerns.
Patient Learning
Clear, contextualized communication about medications reduced participants’ anxiety and distress. Participants indicated that explanations tailored to their situation and opportunities to ask questions improved understanding and supported safer medication use. In contrast, encounters that left patients feeling overwhelmed, embarrassed, or anxious impeded their ability to learn. These emotional barriers limited question-asking and interfered with comprehension of medication instructions.
Patient Participating
When invited to participate in medication-related decision-making, participants reported feeling empowered and engaged in their care. Active inclusion in decisions fostered confidence and collaboration. By contrast, perceived exclusion from decision-making processes—such as being given directives without discussion—led to frustration and disengagement, reducing patients’ willingness to be involved in medication management.
Overall, participants described interrelated experiences across the three PPS domains: belonging influenced willingness to learn and participate, while learning and participation reinforced belonging and trust in the therapeutic relationship.
The findings indicate that psychological safety is integral to effective conversations about medications. In primary and community care settings—where medication decisions are commonly revisited and patients often self-manage—fostering psychological safety may reduce distress, encourage disclosure of concerns, and support adherence to treatment plans.
The study highlights specific communication practices linked to improved psychological safety: listening behaviors that convey respect and validation, clear and contextualized medication explanations, and active invitation for patient participation in decision-making. Conversely, dismissive attitudes, overwhelming information, and exclusion from decisions were linked to negative emotional responses and disengagement.
The authors note that psychological safety around medications is an underdeveloped area and that applying the PPS framework to medication-focused encounters provides insight into how relational and communicative features of care influence patient experiences. They recommend future work to test and implement strategies that address multi-level barriers—patient, provider, and system factors—to promote psychologically safe medication conversations.
Psychological safety shapes how patients experience medication conversations with healthcare providers. Creating environments where patients feel heard, respected, and able to contribute to decisions may lower distress and support patient engagement in medication treatment decisions. The authors call for further research to identify and evaluate interventions that promote psychological safety across levels of care.
The work was supported by the New Initiative and Innovation Award, Network for Improving Health Systems; the University of Toronto Centre for the Study of Pain Scientist Salary Award; and the Undergraduate Summer Research Program at the Leslie Dan Faculty of Pharmacy, University of Toronto. The manuscript states that all relevant data are within the manuscript; additional identifiable raw data are restricted by participant consent and University of Toronto ethics. The authors reported no competing interests that could influence the results or interpretation of the manuscript.