Pharmacy Australian Centre of Excellence, Health and Behavioural Science Department, School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD, 4102, Australia.
Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.
Drugs Aging. 2024 Oct;41(10):821-831. doi: 10.1007/s40266-024-01146-5. Epub 2024 Sep 18.
As dementia progresses, people living with dementia may take high-risk, unnecessary, or ineffective medicines. Cholinesterase inhibitors (ChEIs) may have benefit in some people with dementia; however, up to one third are continued when no longer necessary or safe. Our aim was to co-design a consult patient decision aid (CPtDA) to support shared decision making between healthcare professionals and consumers about continuing or deprescribing ChEIs.
A systematic process was employed to design and test the CPtDA prototype. First, a steering group composed of healthcare professionals and a consumer representative was assembled. Guided by the International Patient Decision Aids Standards, the steering group defined the CPtDA's purpose, scope, and target audience and drafted the prototype for further testing. Interviews with consumers and healthcare professionals were conducted to gain feedback on the content, format, structure, comprehensibility and usability of the CPtDA prototype.
After the steering group developed the CPtDA prototype, interviews were conducted with 11 consumers and six healthcare professionals. The content and format of the decision aid were improved iteratively over three rounds after consolidating the feedback at each round. The main changes included rewording the purpose of the decision aid and simplifying its layout and format. Participants reported that the decision aid is comprehensible and may be useful in practice.
Limited available resources guide shared decision making about deprescribing. This study resulted in a co-designed and alpha-tested CPtDA for people living with dementia and carers to help them review the ongoing need for their ChEIs. Further research is needed to explore using the CPtDA in practice to support people living with dementia and their carers engage in the shared decision-making process about continuing or deprescribing their ChEIs. Our co-designed CPtDA could help people living with dementia and their carers review their goals of care alongside their healthcare professional. This may prompt conversations about appropriately using ChEIs and increase the uptake of deprescribing.
随着痴呆症的进展，痴呆症患者可能会服用高风险、不必要或无效的药物。胆碱酯酶抑制剂（ChEIs）可能对一些痴呆症患者有益；然而，多达三分之一的患者在不再需要或不安全时仍继续服用。我们的目的是共同设计一种咨询患者决策辅助工具（CPtDA），以支持医疗保健专业人员和消费者就继续或减少 ChEIs 的使用进行共同决策。
采用系统的方法设计和测试 CPtDA 原型。首先，由医疗保健专业人员和消费者代表组成的指导小组成立。在国际患者决策辅助工具标准的指导下，指导小组定义了 CPtDA 的目的、范围和目标受众，并起草了进一步测试的原型。对消费者和医疗保健专业人员进行了访谈，以获取对 CPtDA 原型的内容、格式、结构、可理解性和可用性的反馈。
在指导小组开发了 CPtDA 原型后，对 11 名消费者和 6 名医疗保健专业人员进行了访谈。在每一轮整合反馈后，经过三轮迭代改进了决策辅助工具的内容和格式。主要变化包括重新措辞决策辅助工具的目的，并简化其布局和格式。参与者报告说，决策辅助工具是可理解的，在实践中可能是有用的。
有限的可用资源指导了减少用药的共同决策。本研究产生了一种共同设计和 alpha 测试的 CPtDA，供痴呆症患者及其护理人员使用，以帮助他们审查继续使用 ChEIs 的必要性。需要进一步研究以探索在实践中使用 CPtDA 来支持痴呆症患者及其护理人员参与关于继续或减少使用 ChEIs 的共同决策过程。我们共同设计的 CPtDA 可以帮助痴呆症患者及其护理人员在与医疗保健专业人员一起审查他们的护理目标。这可能会促使他们讨论适当使用 ChEIs，并增加减少用药的可能性。
