Communication with patients (and caregivers/family) to inform deprescribing | - Obtain information about experiences with medications (side effects, effectiveness), preferences, and goals of care
- Discuss realistic treatment goals – what do they value the most?
- Elicit fears about deprescribing
|
Communication with patients (and caregivers/family) to achieve shared decision-making about deprescribing | Why? - Discuss why deprescribing of specific medications is being recommended – lack of benefits, risk of harm, etc (tailored to the individual and their goals of care)
- Frame as "not giving up on you" but as optimizing care
- Explain that we may not have good evidence on the benefits and harms of medicines after long-term use
|
How? - Frame deprescribing as a trial, with reassurance that the medication(s) can be restarted if necessary
- Offer alternative strategies to control bothersome symptoms
- Plan tapering/withdrawal process
- Discuss monitoring plan
|
Fears: - Attend to emotion
- Explore and address fears and concerns about deprescribing
- Discuss what to do if symptoms occur (monitoring plan)
|
Communication with other health care professionals | - Activate patient to be custodian of medication list (but responsibility should not be solely placed on the patient)
- Communicate plan clearly to other clinicians
- Collaborate with other clinicians
- Don’t be afraid of stopping/making a recommendation about stopping a medication that is determined to be inappropriate
- Avoid devolving of responsibility – don't expect others to take responsibility for proactive deprescribing
|