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Mapping the Processes of Pharmacist Therapeutic Reasoning: A Scoping Review and Development of the Pharmacist Therapeutic Reasoning Model.

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Bibliographic Details
Title: Mapping the Processes of Pharmacist Therapeutic Reasoning: A Scoping Review and Development of the Pharmacist Therapeutic Reasoning Model.
Authors: Rainkie D; College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. Electronic address: daniel.rainkie@dal.ca., Nazar Z; College of Pharmacy, QU Health, Qatar University, Doha, Qatar., Teunissen P; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands., Könings K; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; School of Health Sciences, University of East Anglia, Norwich, UK.
Source: Research in social & administrative pharmacy : RSAP [Res Social Adm Pharm] 2026 Jan; Vol. 22 (1), pp. 116-127. Date of Electronic Publication: 2025 Sep 01.
Publication Type: Journal Article; Scoping Review
Language: English
Journal Info: Publisher: Elsevier Country of Publication: United States NLM ID: 101231974 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1934-8150 (Electronic) Linking ISSN: 15517411 NLM ISO Abbreviation: Res Social Adm Pharm Subsets: MEDLINE
Imprint Name(s): Original Publication: New York, NY : Elsevier
MeSH Terms: Pharmacists*/psychology , Clinical Reasoning* , Clinical Decision-Making*, Humans ; Professional Role ; Students, Pharmacy/psychology ; Decision Making
Abstract: Background: Pharmacists make complex therapeutic decisions. Yet the reasoning processes that result in these choices, therapeutic reasoning (TR), are poorly defined. Existing models of clinical reasoning often overlook how pharmacists weigh risks and benefits of treatment options.
Aim: To develop a conceptual model that characterizes the processes, subprocesses, and cognitive strategies used during pharmacist TR based on current literature.
Methods: A scoping review was conducted in February 2024 to identify studies describing pharmacist or pharmacy student reasoning during therapeutic decision-making. Data were extracted by two researchers using a standardized form and inductively analyzed. Codes were thematically organized based on shared properties: discrete knowledge, reasoning connections, or modifying influences. Theory use was assessed using the Continuum of Theory Talk framework.
Results: Ten studies met inclusion criteria representing diverse contexts, scope, and reasoning stimuli. A total of 109 unique codes were identified and synthesized into a conceptual pharmacist therapeutic reasoning model (Pharm-TRv1). It consists of three knowledge domains (drug, disease, and patient information), three core reasoning processes connecting these domains (drug-patient, drug-disease, patient-disease), and three to four related subprocesses. The model includes five influencing factors: two external (decision context and entry and exit from reasoning) and three internal cognitive modifiers (metacognition, closing a knowledge gap, and reflection).
Conclusion: Pharm-TRv1 provides a foundational model of pharmacist therapeutic reasoning grounded in current literature. It offers a structured way to describe, teach, and study how pharmacists evaluate treatment options. Future research should further explore specific processes and subprocesses, validate the model, and explore broader theoretical perspectives.
(Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)
Contributed Indexing: Keywords: Cognitive model; Cognitive processes; Pharmacist; Scoping review; Theory talk; Therapeutic reasoning; Treatment decision making
Entry Date(s): Date Created: 20250923 Date Completed: 20251119 Latest Revision: 20251119
Update Code: 20251121
DOI: 10.1016/j.sapharm.2025.08.012
PMID: 40987712
Database: MEDLINE
Description
Abstract:Background: Pharmacists make complex therapeutic decisions. Yet the reasoning processes that result in these choices, therapeutic reasoning (TR), are poorly defined. Existing models of clinical reasoning often overlook how pharmacists weigh risks and benefits of treatment options.<br />Aim: To develop a conceptual model that characterizes the processes, subprocesses, and cognitive strategies used during pharmacist TR based on current literature.<br />Methods: A scoping review was conducted in February 2024 to identify studies describing pharmacist or pharmacy student reasoning during therapeutic decision-making. Data were extracted by two researchers using a standardized form and inductively analyzed. Codes were thematically organized based on shared properties: discrete knowledge, reasoning connections, or modifying influences. Theory use was assessed using the Continuum of Theory Talk framework.<br />Results: Ten studies met inclusion criteria representing diverse contexts, scope, and reasoning stimuli. A total of 109 unique codes were identified and synthesized into a conceptual pharmacist therapeutic reasoning model (Pharm-TRv1). It consists of three knowledge domains (drug, disease, and patient information), three core reasoning processes connecting these domains (drug-patient, drug-disease, patient-disease), and three to four related subprocesses. The model includes five influencing factors: two external (decision context and entry and exit from reasoning) and three internal cognitive modifiers (metacognition, closing a knowledge gap, and reflection).<br />Conclusion: Pharm-TRv1 provides a foundational model of pharmacist therapeutic reasoning grounded in current literature. It offers a structured way to describe, teach, and study how pharmacists evaluate treatment options. Future research should further explore specific processes and subprocesses, validate the model, and explore broader theoretical perspectives.<br /> (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)
ISSN:1934-8150
DOI:10.1016/j.sapharm.2025.08.012