Elderly Patients' Perspectives on the Acceptability of Deprescribing Medicines: A Qualitative Study Protocol

Abstract

The ageing population has resulted in an increase in multimorbidity and polypharmacy, and subsequently the complexity of optimising elderly patients’ medicines. The need for deprescribing can arise from factors such as increased susceptibility to adverse effects of medicines in older age, due to functional and cognitive changes, which increases elderly people’s risk of harm. Previous questionnaire-survey-based research suggests that patients tend not to disagree with deprescribing, but qualitative research on patients’ perspectives on deprescribing appears sparse and focused on specific conditions, circumstances (e.g., terminal illness) or medicines. Further exploration of this area is therefore important for health professionals, and greater understanding in particular is needed about elderly patients’ perspectives on the acceptability of deprescribing and how best to conduct deprescribing consultations. This study aims to explore these issues, with an approach informed by the Theoretical Framework of Acceptability (TFA). Semi-structured, audio-recorded interviews will therefore be undertaken with a purposive sample of approximately 20 hospital in-patients who are =65years of age, prescribed at least one regular medicine and have multimorbidities and/or frailty. Two acute Trusts were identified through existing networks where patients will be identified by the ward pharmacist and recruited to the study by the researcher. Due to the nature of the discussion and the potential vulnerable nature of participants, a distress protocol has been created to support management of any distress or fatigue that may occur. The TFA has been used so far to develop the study objectives and interview guide topics. The interview guide has been structured into five broad topics, which will cover the constructs of the TFA. Interview recordings will be transcribed verbatim and analysed using the Framework Analysis technique, informed by the TFA.