Patient values and preferences on polypharmacy and deprescribing: a scoping review

Forest, Evan W.; Ireland, Melissa; Yakandawala, Uma; Cavett, Teresa; Raman-Wilms, Lalitha; Falk, Jamie; McMillan, Diana E.; Linthorst, Rhys; Kosowan, Leanne; LaBine, Lisa; Leong, Christine

doi:10.1007/s11096-021-01328-w

Cited by 5 publications

(4 citation statements)

References 46 publications

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“…Although this is a common concern in research,66 70 our results showed that it is still not sufficiently implemented in the Valais hospital and local community clinical settings. Previous studies have argued for regular reassessments of their values and preferences and for integrating them into each change in treatment 71 72. Our findings also suggested the need to ensure more adequate responses to pain assessments.…”

Section: Discussionmentioning

confidence: 55%

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

Pereira,

Meyer-Massetti,

del Río Carral

et al. 2023

BMJ Open

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ObjectiveThis study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs).DesignExplanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously.SettingHospital and community healthcare in the French-speaking part of Switzerland.ParticipantsThe quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge.ResultsQuantitative results from older adults’ profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices.ConclusionBy linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders’ perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.

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Section: Discussionmentioning

confidence: 55%

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

Pereira,

Meyer-Massetti,

del Río Carral

et al. 2023

BMJ Open

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“…However, some studies have defined polypharmacy simply as the use of multiple medications. 20 Here, the majority of our population took 3–5 medications, lower than reported for patients with hemodialysis (average 14 ± 4.6). 21 This low number of prescribed medications might have influenced attitudes towards deprescribing.…”

Section: Discussionmentioning

confidence: 60%

Are Saudi Arabian Patients Willing to Be Deprescribed Their Medications? An Exploratory Study

Alhurishi,

AlQahtani

2024

PPA

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Purpose Deprescribing is a complex process that requires active patient involvement, so the patient’s attitude to deprescribing is crucial to its success. This study aimed to assess predictors of Saudi Arabian patients’ willingness to deprescribe. Patients and Methods In this cross-sectional study, adult patients from two hospitals in Riyadh completed a self-administered questionnaire gathering data on demographic information and the Arabic revised Patients’ Attitudes Towards Deprescribing (rPATD) questions. Descriptive analysis and binary logistic regression were used to analyze the data. Results A total of 242 patients were included (mean age 59.8 (SD 11.05) years, range 25–87 years; 40% 60–69 years; 54.1% female). The majority (90%) of participants were willing to have medications deprescribed. Willingness to deprescribe was significantly associated with the rPATD involvement factor (OR=1.866, 95% CI 1.177–2.958, p=0.008) and the patient’s perception of their health status (OR=2.08, CI=1.058–4.119, p=0.034). Conclusion The majority of patients were willing to have one or more medications deprescribed if recommended by their doctors. Patient perceptions about their own health and their involvement in deprescribing were important predictive factors that could shape counseling and education strategies to encourage deprescribing.

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“…35,45,46 As well as this, the signi cance of shared collaborative conversations between clinicians, patients, and family members or carers was also echoed. 14 Much focus within previous studies has rightly placed patient preferences in deprescribing at the centre, [47][48][49] however, future research may wish to further explore the dynamics and interplay between the preferences of others involved in a person's care.…”

Section: Discussionmentioning

confidence: 99%

“Starting to think that way from the start": Approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views.

Robinson-Barella,

Richardson,

Bayley

et al. 2024

Preprint

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Background: Deprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context. Methods: Semi-structured interviews were conducted with healthcare professionals in-person or via video call, between August – January 2023. Perspectives on approaches to deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394). Results: Twenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of deprescribing; and (3) involving the patient and family/caregivers in deprescribing decision-making. Conclusions: This study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient’s care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can best be supported in the shared decision-making processes of deprescribing. Trial registration: Ethical approval was obtained from the NHS Health Research Authority (ref 305394).

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Patient values and preferences on polypharmacy and deprescribing: a scoping review

Cited by 5 publications

References 46 publications

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

Are Saudi Arabian Patients Willing to Be Deprescribed Their Medications? An Exploratory Study

“Starting to think that way from the start": Approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views.

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