School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada.
Patient. 2018 Feb;11(1):17-28. doi: 10.1007/s40271-017-0258-4.
Proton pump inhibitors (PPIs) treat various upper gastrointestinal (GI) diseases. Around 50% of patients may remain on PPIs long-term without ongoing need. Eligible patients should be offered the choice of continuing their PPI or trying to reduce/stop their PPI (deprescribing), a choice dependent on values and preferences.
Our objective was to systematically scope the available evidence on patient values and preferences surrounding continued PPI treatment and/or the decision to try a reduction in their PPI. We searched the MEDLINE, Embase, and Cochrane Library databases and the grey literature as of 9 August 2016 for studies of any design examining patient values and preferences toward PPI treatment and/or deprescribing. We included patients aged ≥18 years taking PPIs for upper GI diseases.
We located 12 eligible studies (seven surveys, four qualitative studies, one randomized controlled trial). One study only examined values and preferences towards reducing PPI use, five studies looked only at PPI treatment (initiation/continuation), four studies assessed both PPI treatment and reduction, and two studies evaluated PPI treatment and switching (to alternative PPIs). Patients value symptom control highly and worry about symptoms returning if the PPI is reduced. They are encouraged to consider reducing their PPI if a clinician provides advice and education. All five studies that examined reducing PPI use suggest patients should understand the rationale for considering continuation versus deprescribing of PPIs and should know what to expect from deprescribing. Patients are encouraged by knowing they can return to their previous dose if necessary. Our results were limited by the small sizes of studies and the heterogeneous populations.
Patients are willing to discuss the option of continuing PPI use or trying to reduce their PPI; however, a range of attitudes exist. The results suggest that reducing a PPI is a preference-sensitive decision. Therefore, patient attitudes should be elicited and incorporated into shared decision making surrounding the decision to continue or try deprescribing a PPI, and structured tools will be helpful to encourage this.
质子泵抑制剂（PPIs）可治疗各种上消化道（GI）疾病。约有 50%的患者可能在没有持续需求的情况下长期使用 PPI。应向符合条件的患者提供继续使用 PPI 或尝试减少/停止 PPI（停药）的选择，这一选择取决于价值观和偏好。
我们的目的是系统地评估有关继续使用 PPI 治疗和/或决定尝试减少 PPI 方面的患者价值观和偏好的现有证据。我们检索了 MEDLINE、Embase 和 Cochrane 图书馆数据库以及截至 2016 年 8 月 9 日的灰色文献，以寻找任何设计研究，这些研究都检查了患者对 PPI 治疗和/或停药的价值观和偏好。我们纳入了年龄≥18 岁、因上 GI 疾病服用 PPI 的患者。
我们确定了 12 项符合条件的研究（7 项调查、4 项定性研究、1 项随机对照试验）。只有一项研究仅考察了减少 PPI 使用的价值观和偏好，5 项研究仅关注 PPI 治疗（起始/持续），4 项研究评估了 PPI 治疗和减少，2 项研究评估了 PPI 治疗和转换（替代 PPI）。患者非常重视症状控制，如果减少 PPI，他们担心症状会复发。如果临床医生提供建议和教育，他们会被鼓励考虑减少 PPI。所有 5 项研究均表明，对于考虑继续使用 PPI 或尝试停药，患者应了解继续使用 PPI 与停药的基本原理，并了解停药后的预期情况。如果有必要，他们知道可以恢复到以前的剂量，这一点让患者感到欣慰。我们的研究结果受到研究规模较小和人群异质性的限制。
患者愿意讨论继续使用 PPI 或尝试减少 PPI 的选择，但存在各种态度。结果表明，减少 PPI 是一个偏好敏感的决策。因此，应该了解患者的态度，并将其纳入继续使用或尝试停药的决策中，同时使用结构化工具来鼓励这一点。
