Martine Kruijtbosch

207 Summa r y hampered mostly because of the behaviour of patients or other health professionals. The interventions of third parties, such as legal representatives, regulators, or health insurers sometimes further complicated the pharmacist-patient relationship. Pharmacists often felt that patients and other health professionals disregarded their pharmaceutical expertise and undermined the trust vital to the pharmacist-patient relationship. This lack of regard and trust impeded pharmacists’ decisions regarding appropriate and safe pharmacotherapy because, for example, relevant patient information needed for these decisions was not shared. We concluded that the themes were more diverse than in previous studies. Our study in Chapter 2.2 aimed to address which professional values (formulated in the Dutch Charter of Professionalism) and which other values could be identified in the same 128 eligible moral dilemma narratives as analysed in Chapter 2.1. We also aimed to present customised descriptions of the professional values for pharmacists working in community pharmacy. All professional values played a role in the moral dilemmas. ‘Commitment to the patient’s well-being’ and ‘reliability and care’ were present the most and ‘social responsibility’ was present the least. We found thirteen other values which could all be categorised under the existing professional values. These values could also be used for the customisation of the value descriptions for community pharmacists. The descriptions were adapted the most for the professional values ‘reliability and care’ and ‘social responsibility’. Moreover, we changed the names of these two values to ‘reliable and caring’ and ‘responsibility to society’ to better fit with the descriptions. We concluded that these customised professional value descriptions can enable community pharmacists to better recognise moral dilemmas in practice, and support them to advance their pharmaceutical care practice. In Part 3 we presented three studies on moral reasoning of Dutch (early career) community pharmacists. We tested the applicability of the Australian moral reasoning test for community pharmacy, the Professional Ethics in Pharmacy test (PEP test), to early career Dutch pharmacists ( Chapter 3.1 ). The PEP test is designed to measure three developmental levels of moral reasoning (i.e. moral reasoning perspectives [MRPs]): (1) a business orientation MRP, (2) a rules and regulation MRP and (3) a professional ethics MRP. The PEP test consists of three moral dilemma scenarios from pharmacy practice wherein the respondent is asked what should be done to resolve the dilemma. The scenarios are accompanied by thirteen statements that represent the three MRPs. Respondents rate and rank the importance of each of these statements to the extent these match their (tacitly) preferred MRP from which they usually - often unknowingly - reason when making and taking decisions in pharmacy practice. In the studies in Chapters 3.2 and 3.3 , we adapted the PEP test for use in the context of Dutch pharmacy and professionalism (PEP-NL test) and investigated to what extent community pharmacists made use of the three MRPs in their intended handling of drug shortages.