James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
Division of Geriatric and Palliative Medicine, McGovern Medical School, Houston, TX, USA.
Support Care Cancer. 2023 Oct 17;31(12):636. doi: 10.1007/s00520-023-08084-9.
To describe emotional barriers and facilitators to deprescribing (the planned reduction or discontinuation of medications) in older adults with cancer and polypharmacy.
Virtual focus groups were conducted over Zoom with 5 key informant groups: oncologists, oncology nurses, primary care physicians, pharmacists, and patients. All groups were video- and audio-recorded and transcribed verbatim. Focus group transcripts were analyzed using inductive content analysis, and open coding was performed by two coders. A codebook was generated based on the initial round of open coding and updated throughout the analytic process. Codes and themes were discussed for each transcript until consensus was reached. Emotion coding (identifying text segments expressing emotion, naming the emotion, and assigning a label of positive or negative) was performed by both coders to validate the open coding findings.
All groups agreed that polypharmacy is a significant problem. For clinicians, emotional barriers to deprescribing include fear of moral judgment from patients and colleagues, frustration toward patients, and feelings of incompetence. Oncologists and patients expressed ambivalence about deprescribing due to role expectations that physicians "heal with med[ication]s." Emotional facilitators of deprescribing included the involvement of pharmacists, who were perceived to be neutral, discerning experts. Pharmacists described emotionally aware communication strategies when discussing deprescribing with other clinicians and expressed increased awareness of patient context.
Deprescribing can elicit strong and predominantly negative emotions among clinicians and patients which could inhibit deprescribing interventions. The involvement of pharmacists in deprescribing interventions could mitigate these emotional barriers.
ClinicalTrials.gov Identifier: NCT05046171 . Date of registration: September 16, 2021.
描述癌症和多种药物治疗的老年患者减少或停止用药（计划性减药或停药）过程中的情绪障碍和促进因素。
通过 Zoom 虚拟焦点小组，与 5 个关键信息组进行了交流：肿瘤学家、肿瘤护士、初级保健医生、药剂师和患者。所有小组均进行了视频和音频录制，并进行了逐字转录。对焦点小组的转录本进行了归纳内容分析，由两名编码员进行了开放式编码。根据初始开放编码一轮生成了一个编码手册，并在整个分析过程中进行了更新。对每个转录本进行了讨论，直到达成共识。两位编码员对情绪编码（识别表达情感的文本片段、命名情感并分配积极或消极的标签）进行了操作，以验证开放式编码的结果。
所有组都认为多种药物治疗是一个重大问题。对于临床医生而言，减少用药的情绪障碍包括担心来自患者和同事的道德评判、对患者的挫败感以及能力不足的感觉。肿瘤学家和患者对减少用药表示矛盾，因为医生“用药治愈”的角色期望。减少用药的情绪促进因素包括药剂师的参与，他们被认为是中立的、有洞察力的专家。药剂师描述了在与其他临床医生讨论减少用药时情绪感知的沟通策略，并表示增加了对患者背景的认识。
减少用药可能会在临床医生和患者中引起强烈的、主要是负面的情绪，这可能会抑制减少用药的干预措施。药剂师参与减少用药干预措施可能会减轻这些情绪障碍。
ClinicalTrials.gov 标识符：NCT05046171。注册日期：2021 年 9 月 16 日。
