养老院居民对讨论停用预防药物的想法。
Nursing Home Residents' Thoughts on Discussing Deprescribing of Preventive Medications.
机构信息
Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark.
出版信息
Drugs Aging. 2020 Mar;37(3):187-192. doi: 10.1007/s40266-020-00746-1.
BACKGROUND
Deprescribing of preventive medications may be considered in some nursing home residents. It is important to understand how to effectively communicate around this complex decision, from both a physician and resident perspective.
OBJECTIVE
The objective of this study was to explore how nursing home residents would like to discuss deprescribing of preventive medications with their physicians.
METHODS
We conducted a qualitative study with face-to-face, semi-structured interviews. Participants were Danish nursing home residents aged ≥70 years deemed cognitively able to participate by nursing staff. They were taking one or more of statins, antihypertensives, antihyperglycemics, or antiplatelets. Interviews were audio recorded and transcribed verbatim. Analysis was conducted based on systematic text condensation.
RESULTS
Nine nursing home residents (median age 85 years, seven female) were interviewed. Participants were generally aware of their overall number of medications but unaware of specific medications and why they were taking them. All participants displayed a high degree of trust in their physicians, preferring to defer decisions to them, and generally believed their medication was necessary if their physician had prescribed it. Residents would be open to deprescribing if their physician suggested it but were not aware of the possibility to be involved in the decision (e.g., discuss goals of care and treatment preferences) and had difficulty imagining what they could discuss with their physician about a deprescribing decision.
CONCLUSION
The interviewed nursing home residents could not imagine how they might discuss potential deprescribing of preventive medications with their physician, and what topics would be important. Future work should explore how nursing home residents can be encouraged to be part of such discussions and investigate ways to have residents share their goals and preferences regarding deprescribing.
背景
在一些养老院居民中，可能会考虑减少预防性药物的使用。从医生和居民的角度理解如何有效地围绕这一复杂决策进行沟通非常重要。
目的
本研究的目的是探讨养老院居民希望如何与医生讨论减少预防性药物的使用。
方法
我们进行了一项定性研究，采用面对面、半结构化访谈的方式。参与者为丹麦养老院≥70 岁的居民，护理人员认为他们认知能力能够参与。他们正在服用一种或多种他汀类药物、降压药、抗高血糖药或抗血小板药。访谈进行了录音，并逐字转录。分析是基于系统文本压缩进行的。
结果
共对 9 名养老院居民（中位年龄 85 岁，7 名为女性）进行了访谈。参与者通常了解他们服用的药物总数，但不了解具体的药物及其服用原因。所有参与者都对他们的医生高度信任，倾向于将决策交予医生，并且普遍认为如果医生开了药，他们的药物就是必要的。如果医生建议减少药物的使用，居民们会愿意减少用药，但他们不知道自己可以参与决策（例如，讨论护理目标和治疗偏好），也难以想象他们可以与医生讨论减少药物的决定。
结论
接受访谈的养老院居民无法想象他们可以如何与医生讨论减少预防性药物的使用，也不知道哪些话题是重要的。未来的工作应该探讨如何鼓励养老院居民参与此类讨论，并研究如何让居民分享他们对减少药物的目标和偏好。
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