Exploring how GPs discuss statin deprescribing with older people: a qualitative study

Abstract

BackgroundGiven uncertainty surrounding benefits and harms, shifts in patient health status, and changing patient goals and preferences, statin deprescribing may be considered in some older people. This decision should be carefully discussed between GPs and patients.AimTo explore how GPs discuss deprescribing of statins with their older patients.Design & settingA qualitative study was undertaken using face-to-face, semi-structured interviews with Danish GPs from the regions of Southern Demark and Zealand.MethodThe GP participants belonged to group practices and were identified from personal networks and snowballing. The interviews lasted approximately 30 minutes and were conducted in English. They were analysed using systematic text condensation.ResultsA total of 11 GPs were interviewed and three themes were identified. (1) Reason for initiating a discussion: statin deprescribing mainly came up when GPs reviewed medication lists. There were differences between GPs regarding when or if they brought up deprescribing. (2) Discussion topics: GPs often discussed their interpretation of evidence surrounding statin use in older people. There were differences in how and if GPs discussed patient preferences. GPs viewed uncertainty and life expectancy as difficult to discuss. (3) Depth of discussion: the perceived level of patient engagement, and clinical context, could influence the extent of discussion.ConclusionGPs identified a range of topics that could be discussed with patients surrounding statin deprescribing. The depth and content of discussions varied according to the situation, and between GPs. Challenges may exist in communicating around certain topics, such as uncertainty and life expectancy. Further understanding of how to best communicate around challenging topics, and development of structured frameworks, may help facilitate statin deprescribing discussions. Identifying what patients think is important to discuss would provide necessary insight to promote quality discussions and shared understanding of the decision.

Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

“…However, studies show that such medications are generally discontinued very late in the disease trajectory [ 1 , 2 , 3 , 4 ]. This may be due to patient perception of deprescribing, to the physician’s opinion on the effects of statins in the elderly or to physician fear of causing harm to the patient [ 5 , 6 , 7 ].…”

Statin Discontinuation and Cardiovascular Events Among Older People in Denmark

“…For instance, statin discontinuation may reflect an overall preference for less medical care and a willingness to shift from preventive or curative goals of care to a more palliative approach. Poor health and severe frailty may also be associated with an increased likelihood of statin discontinuation 43 , 44 and with a reduced likelihood of receiving revascularization procedures, particularly coronary artery bypass graft. 45 , 46 , 47 Our post hoc analyses support this hypothesis because we found a lower rate of coronary artery bypass graft in the discontinuation group than in the continuation group, especially in the secondary prevention cohort.…”

Cross-cultural adaptation and psychometric validation of a Spanish version of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire

“…However, in clinical practice, shared decision-making is influenced by multiple factors, and there is wide variability depending on the situation and between different physicians. Physicians may be reluctant to initiate conversations about deprescribing because they falsely perceive their patients as having a medication dependence or out of fear that the patient could interpret the deprescribing attempt as their care being abandoned 16 17. Among the patient-dependent factors are the degree to which they trust medical advice, any cognitive biases leading them to only listen to positive information, difficulties in processing information and the lack of tools that allow them to explore their preconceived notions regarding deprescribing 18 19…”