Barriers to and Enablers of Proactive Deprescribing Among Adults Aged ≥65 Years
| Category | Theme (type) | Subthemes and related quotes (patient and quote identifier) |
|---|---|---|
| Medication valuation | Negative valuation of a medication (enabler) | Perceived burden of polypharmacy My mother had Parkinson’s disease, and she took more than 10 different medicines a day. I thought, “If she takes this many pills, no wonder she has no appetite,” and I don’t want to take so many pills. (6-10) Fear that medication may cause harm I am still concerned about the increasing number of medications. I wonder if it will affect my liver. (15-9) Lack of perceived benefits I’m a little unclear on whether this medicine is working, and I’ve never broken bones before, so I thought, well, I don’t have to take it. (3-5) Experience of successful deprescribing I never felt worse when the doctor reduced my meds, and I felt good because nothing changed. (9-10) |
| Positive perspective on medication (barrier) | Acceptance of current situation through trust in prescriber When the doctor says, “This is important (medicine),” I’m taking it because I have no choice, even though I want to stop taking it. He knows better than me. (6-7) High expectations for medications My blood pressure got better after I started taking the new medicine. I realized how important it is to take medicines. (13-3) | |
| Decision-making preference | Proactive decision-making involvement preference (enabler) | Preference for patient-centered decision making about medicines It’s really important for me to know my condition well. Then the conversation (with the doctor) would naturally go in the direction of what drugs to use to improve my condition. (10-17) Motivation for disease control through lifestyle modification I can’t help it, it’s fate that I get sick, but I have to make some effort on my own. I think I can manage my high blood pressure and cholesterol a little more on my own. (8-2) |
| Passive patient involvement and perceived lack of capability (barrier) | Preference of deferring decision to prescriber I believe I should leave my health and medications to my doctor. I take the medicines I receive as a matter of course, morning, noon, and night, and before going to bed. (1-10) Difficulty in expressing opinions due to reticence toward the physician There are times when I wonder if I really need these medicines. But as a patient, I am a little hesitant to ask the doctor to reduce the pills. I think everyone feels that way. (18-11) Perceived lack of capability to deprescribe I am sure that with my age, I will no longer be able to cope on my own. I would like to leave it to the doctor to take care of my health problems. (13-7) | |
| Openness to deprescribing | Open to deprescribing proposal based on trust in prescriber (enabler) | Trust in prescriber I talk a lot during the examination, but she answers my questions without making me feel uncomfortable. That’s why I look forward to coming here. (7-9) Openness to deprescribing if suggested by prescriber If the doctor says it’s okay to reduce the pill(s), then I will accept it. I would feel safer if I had his approval. (19-4) |
| Caution due to fear of change or satisfaction with the status quo (barrier) | Fear of changing current medications This medicine cures my stomach heaviness. I’m afraid to stop taking this because I think it helps me live without symptoms. (9-8) Satisfaction with the status quo The doctor examines and gives me medicines that best suit me, so taking them is the safest way. I’m already 80, and my job is to go to the hospital and take the pills. (7-2) |