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Describing deprescribing: How do GPs discuss deprescribing topics with their patients, and how in-depth do they go?

Thompson W, Jarbøl D, Nielsen JB, Haastrup P, Pedersen LB. GP preferences for discussing statin deprescribing: a discrete choice experiment. Fam Pract. 2022;39(1):26-31. doi:10.1093/fampra/cmab075

Although there is ample evidence on the benefits of deprescribing for older patients, providers’ deprescribing-related communication preferences are less understood. Given that clinicians often have the greatest influence on patients’ deprescribing decisions, it is crucial for researchers to understand clinician preferences. Former USDeN Junior Investigator Intensive (JII) scholar Dr. Wade Thompson and his team at the University of Southern Denmark narrowed in on the preferences of general practitioners (GPs) in Denmark, who are responsible for the majority of prescribing for Danish patients.

The study team conducted a discrete choice experiment (DCE), which required participants to choose between alternative discussions with hypothetical patients. The DCE involved statin treatment and assessed GPs’ preferred discussion length (‘no discussion,’ ‘brief discussion,’ or ‘detailed discussion’) for four different topics: goals of treatment, evidence on statin use in older adults, adverse effects, and uncertainty. Coefficients were used to characterize the perceived importance of each topic relative to other topics.

90 Danish GPs completed the DCE. On average, respondents rated ‘goals of treatment’ (statin therapy) as the most important discussion topic, with the three other topics (evidence, adverse effects, and uncertainty) approximately tied for second place in relative importance. GPs were much more likely to choose a brief discussion over a detailed discussion for all topics. While researchers observed a near-consensus in favor of discussion brevity, researchers observed a great deal of heterogeneity in the perceived importance of each topic.

The study team concluded that GPs have appreciably different preferences for discussing statin deprescribing but noted that these preferences may not be generalizable to other specialties, medication classes, or countries with different reimbursement structures. They suggested accounting for heterogeneity in clinician preferences when designing future deprescribing interventions.

According to Dr. Thompson, fixed communication guidelines may not be well-suited to deprescribing conversations. He offers his perspective below:

“From our work, GPs seem to have their own individual style and approach for communicating with patients about statin deprescribing and seem to tailor their communication to individual patients and clinical situations. There are so many different types of patients and sets of circumstances, and from other work in this field we know that different patients have different decision-making and communication preferences. It might be that a communication tool or decision aid would need to be able to accommodate the flexibility not only in GP styles, but also be adaptable to individual patients’ clinical contexts and decision-making preferences to be useful. I honestly don’t know whether such a tool is achievable or what it would look like, but it doesn’t seem like a very rigid, prescriptive tool would be the most practical in this context. It is also unlikely that a tool alone is THE answer, but hopefully it could at least effectively facilitate communication about the decision for many patients and providers.”  

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