Communication and decision-making about medicines and deprescribing: perspectives of older adults, their companions, and clinicians

This thesis aimed to explore communication and decision-making about medicines and deprescribing from the perspectives of older patients, their companions, pharmacists and GPs. A series of qualitative and mixed methods studies provided an in-depth analysis of the attitudes and experiences of key players involved in the deprescribing process in clinical practice. The first study explored decision-making about medicines and deprescribing in healthy and frail older patients and their companions. Study 2 involved the development and feasibility testing of a communication tool to support shared decision making with older patients and accredited pharmacists in the context of Home Medicines Reviews (HMRs), using observations, interviews and surveys. The final study explored GPs’ perspectives on the value of eliciting patient goals and preferences in making decisions about medicines and the utility of medication reviews. This thesis revealed substantial differences between older patients, pharmacists and GPs in their experiences with and attitudes towards medicines discussions. Older patients varied in terms of their attitudes towards medicines, willingness to deprescribe, and decision-making preferences. Pharmacists varied in their approach to HMRs, their communication style and their perceived role in communicating with patients about their goals and preferences. Finally, GPs varied in how important they considered patients’ goals and preferences to be, how they prioritised medicines, their approach to deprescribing, and how they utilised HMRs. Becoming familiar with the differences in these three key players could facilitate medicines optimisation and engaged communication. Indeed, tailoring to these differences could improve interventions such as decision support tools, goal elicitation strategies and conversation guides to support shared decision making about deprescribing