Fried Terri R, Ouyang Na, Gnjidic Danijela, Green Ariel, Hilmer Sarah, Holmes Holly M, Ko Sandra, Mecca Marcia, Reeve Emily, Reyes Carmen E, Schoenborn Nancy L, Singh Ranjit, Street Richard, Wahler Robert G, Funaro Melissa C
Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
J Am Geriatr Soc. 2025 Mar;73(3):717-727. doi: 10.1111/jgs.19305. Epub 2024 Dec 11.
Deprescribing, the process of identifying and discontinuing potentially harmful or unnecessary medications, is a key component of caring for older persons. Communication is central to deprescribing. This study's objectives were to create a conceptual framework for deprescribing communication and to apply the framework to evaluate current and potential uses of communication in deprescribing.
The consensus development working group comprises an international set of 14 experts in geriatrics, clinical pharmacology, communication, community outreach, and care partner stakeholders. Critical literature reviews describe (a) components of communication used in deprescribing randomized clinical trials (RCTs) and (b) the content of studies examining deprescribing communication, knowledge, attitudes, and values.
The framework demonstrates that communication extends beyond interactions between clinicians and patients. Communication can occur at the health system level, involving methods such as patient-specific feedback materials and academic detailing. Communication can also occur at the community level, involving entities such as pharmaceutical companies, the internet, community groups, and guidelines. Evaluation of the summary of RCTs against the framework demonstrates that intervention studies overwhelmingly focus on communication in individual clinical and health system-based encounters. Evaluation of the summary of observational studies demonstrates that there has been little study of the communication methods and styles themselves.
Potentially untapped opportunities exist to expand the use of different approaches for communication in deprescribing interventions, particularly in the community setting. More studies are required to elucidate and personalize the best content and style of deprescribing communication.
减药，即识别并停用潜在有害或不必要药物的过程，是老年护理的关键组成部分。沟通是减药的核心。本研究的目的是创建一个减药沟通的概念框架，并应用该框架评估减药中沟通的当前及潜在用途。
共识发展工作组由来自老年医学、临床药理学、沟通、社区推广及护理伙伴利益相关者等领域的14名国际专家组成。批判性文献综述描述了（a）减药随机临床试验（RCT）中使用的沟通组成部分，以及（b）研究减药沟通、知识、态度和价值观的研究内容。
该框架表明，沟通不仅限于临床医生与患者之间的互动。沟通可发生在卫生系统层面，包括患者特定反馈材料和学术详述等方法。沟通也可发生在社区层面，涉及制药公司、互联网、社区团体和指南等实体。对照该框架对RCT总结进行评估表明，干预研究绝大多数聚焦于个体临床及基于卫生系统的接触中的沟通。对观察性研究总结进行评估表明，对沟通方法和风格本身的研究很少。
在减药干预中，尤其是在社区环境中，扩大使用不同沟通方法可能存在尚未挖掘的机会。需要更多研究来阐明并个性化减药沟通的最佳内容和风格。
