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Master of Public Health

Patient-reported barriers and enablers to deprescribing recommendations during a clinical trial

AUTHORS

Kim JL , Lewallen KM , Hollingsworth EK , Shah AS , Simmons SF , Vasilevskis EE , . The Gerontologist. 2022 7 26; ().

ABSTRACT

BACKGROUND AND OBJECTIVES: Effective deprescribing requires shared decision-making between a patient and their clinician, and should be used when implementing evidence-based de-prescribing conversations. As part of the Shed-MEDS clinical trial, this study assessed barriers and enablers that influence patient decision-making in deprescribing to inform future implementation efforts and adaptations.

RESEARCH DESIGN AND METHODS: Shed-MEDS, a randomized controlled deprescribing trial, included hospitalized older adults discharging to post-acute care facilities. A trained clinician reviewed each participant’s medical history and medication list to identify medications with potential for deprescribing. The study clinician then conducted a semi-structured patient-centered deprescribing interview to determine patient (or surrogate) concerns about medications and willingness to deprescribe. Reeve et al.’s 2013 framework was used to categorize barriers and enablers to deprescribing from the patient’s perspective, including “appropriateness of cessation”, “fear”, “dislike of a medication”, “influences”, and “process of cessation”.

RESULTS: Overall, participants/surrogates (N= 177) agreed with 63% (883 total medications) of the study clinician’s deprescribing recommendations. Thematic analysis revealed that “appropriateness” of a medication was the most common barrier (88.2%) and enabler (67.3%) to deprescribing. Other deprescribing enablers were in the following domains: “influences” (22.7%), “process” (22.5%), “pragmatic” (19.4%), and “dislike” (5.3%).

DISCUSSION AND IMPLICATIONS: Use of a semi-structured deprescribing interview conversation tool allowed study clinicians to elicit individual barriers and enablers to deprescribing from the patient’s perspective. Participants in this study expressed more agreement than disagreement with study clinicians’ deprescribing recommendations. These results should inform future implementation efforts that incorporate a patient-centered framework during deprescribing conversations.

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