Research project - PONDER
Developing a patient-directed knowledge tool to support shared decision-making for deprescribing in palliative care.
Deprescribing is the process of reducing or stopping medications that may no longer help or could be causing harm. It aims to lessen the medication load and improve the patient’s quality of life.
Currently, there is limited understanding of the challenges involved in making deprescribing decisions for patients in palliative care.
This qualitative study explored the views of healthcare professionals to better understand these challenges and identify potential solutions for deprescribing in a palliative care setting.
Adam Todd, Professor of Pharmaceutical Public Health and Deputy Head of the School of Pharmacy at Newcastle University.
Dr. Joanna Elverson, Specialist Palliative Medicine Consultant at St Oswald’s Hospice.
This project was funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number Award ID: NIHR202283).
December 2021 – November 2023
This phased study researched challenges of deprescribing in palliative care through reviews, interviews, and focus groups/workshops.
These were used to create a patient-directed knowledge tool to support decision-making.
Phase 1
A scoping review was undertaken to establish the challenges of shared decision-making in palliative care, as well as report on existing patient-directed knowledge tools.
Phase 2
Qualitative, semi-structured interviews were conducted with healthcare professionals involved in providing palliative care, patients receiving palliative care, and their family members or close friends, to establish deprescribing needs and challenges from each participant’s perspective.
Phase 3
Informed by the findings from Phases 1 and 2, a series of persona scenarios were developed that considered the different needs and challenges of deprescribing. 2 co-design workshops were delivered. The first workshop established the key requirements of the tool, as well as the most appropriate tool type. The second workshop applied the prototype tool to different persona scenarios to consider further refinements.
20 healthcare professionals were interviewed, including medical consultants, nurses, specialist pharmacists, and general practitioners (GPs).
Participants described the importance of deprescribing decision-making and emphasised that it should be a considered, proactive, and planned process.
Three themes were developed from the data:
- Professional attitudes, competency, and responsibility towards deprescribing
- Changing the culture of deprescribing
- Involving the patient and family/caregivers in deprescribing decision-making
The study found that healthcare professionals identified the need to make deprescribing a proactive part of a patient’s care, rather than a reactive consequence.
Future work should explore how healthcare professionals, patients, and their families can be supported in the shared decision-making processes of deprescribing.
Read the published report below.
Read the report