Patient, carer and healthcare professional perspectives on deprescribing in surgical wards: A mixed methods study

Background: The perspectives of patients and healthcare professionals regarding deprescribing in surgical wards within hospital settings are unknown. Objective: To explore current practices, attitudes, and the enablers and barriers to deprescribing in hospital for older surgical inpatients from the perspectives of doctors, pharmacists, patients and carers. Methods: A mixed methods study was performed. Two surveys were administered Australia-wide (revised Patients’ Attitudes Towards Deprescribing questionnaire for patients/carers and Deprescribing Self-Efficacy Survey for doctors/pharmacists). Interviews, focus groups and observations of ward rounds were conducted with participants from five Australian hospitals. Quantitative data were analysed descriptively, while qualitative data were examined using a combined inductive and deductive approach, with results triangulated. Results: There were 109 survey participants (58 doctors/pharmacists and 51 patients/carers), 28 interview/focus group participants (15 doctors/pharmacists and 13 patients/carers) and eight ward round participants. Doctors and pharmacists reported low to moderate levels of confidence in deprescribing. While most patients and carers were satisfied with their medications, they expressed a willingness to consider deprescribing. Five themes were identified from the interviews, focus groups and ward round observations; 1) deprescribing is not a priority, 2) medication review occurs in response to triggers, 3) knowledge about deprescribing is limited, 4) deprescribing requires a team effort and 5) trust, rapport and communication are essential for successful deprescribing. Conclusions: Doctors working on surgical wards are unlikely to proactively deprescribe medications. A collaborative patient-centred approach involving geriatricians, clinical pharmacologists and pharmacists, along with educational interventions may facilitate deprescribing for surgical patients.