Abstract
Background
Patients with limited life expectancy (LLE) often use potentially inappropriate medications (PIMs), which is associated with negative health consequences. Deprescribing of these PIMs remains poorly enacted in primary care.
Aim
To explore factors influencing deprescribing in community-dwelling patients with LLE in primary care from the perspectives of patients, informal caregivers and primary health care professionals.
Methods:
A qualitative systematic review was performed from inception to January 2025, directed by the PALETTE framework. Peer-reviewed, empirical studies were included if they reported on adult patients with LLE or a representative patient profile, living independently. Data were analysed using inductive thematic synthesis.
Results
23 studies were included. Eighteen explored factors influencing deprescribing in general, while four studies focused on specific medications. Three hierarchically structured themes were identified: (1) Perceptions of (de)prescribing: personal beliefs and feelings towards (de)prescribing impacting initial willingness to deprescribe. These perceptions serve as the premise for (2) the deprescribing conversation: the communicative and practical approach that affect ultimate decision-making. Both the perceptions and deprescribing conversation are embedded in (3) the context of care: factors considering interprofessional collaboration and prerequisites on a health system level.
Conclusions
This systematic review shows that a diverse range of interdependent factors influence the deprescribing process in community-dwelling patients with LLE in primary care. Based on these factors, a multidimensional strategy incorporating a patient-driven approach, education, collaborative efforts and an effective structural integration of the deprescribing process, should be adopted when developing deprescribing interventions, ultimately aiming to improve quality of life.
Patients with limited life expectancy (LLE) often use potentially inappropriate medications (PIMs), which is associated with negative health consequences. Deprescribing of these PIMs remains poorly enacted in primary care.
Aim
To explore factors influencing deprescribing in community-dwelling patients with LLE in primary care from the perspectives of patients, informal caregivers and primary health care professionals.
Methods:
A qualitative systematic review was performed from inception to January 2025, directed by the PALETTE framework. Peer-reviewed, empirical studies were included if they reported on adult patients with LLE or a representative patient profile, living independently. Data were analysed using inductive thematic synthesis.
Results
23 studies were included. Eighteen explored factors influencing deprescribing in general, while four studies focused on specific medications. Three hierarchically structured themes were identified: (1) Perceptions of (de)prescribing: personal beliefs and feelings towards (de)prescribing impacting initial willingness to deprescribe. These perceptions serve as the premise for (2) the deprescribing conversation: the communicative and practical approach that affect ultimate decision-making. Both the perceptions and deprescribing conversation are embedded in (3) the context of care: factors considering interprofessional collaboration and prerequisites on a health system level.
Conclusions
This systematic review shows that a diverse range of interdependent factors influence the deprescribing process in community-dwelling patients with LLE in primary care. Based on these factors, a multidimensional strategy incorporating a patient-driven approach, education, collaborative efforts and an effective structural integration of the deprescribing process, should be adopted when developing deprescribing interventions, ultimately aiming to improve quality of life.
| Original language | English |
|---|---|
| Publication status | Published - 19 Sept 2025 |
| Event | WONCA World Conference 2025 - Lisboa Congress Centre, Lisbon, Portugal Duration: 17 Sept 2025 → … |
Conference
| Conference | WONCA World Conference 2025 |
|---|---|
| Country/Territory | Portugal |
| City | Lisbon |
| Period | 17/09/25 → … |
Keywords
- Deprescriptions
- Inappropriate Prescribing
- Polypharmacy
- Primary Health Care
- Palliative Care
- Systematic Review