Communication as a key component of deprescribing: Conceptual framework and review of the literature

Background: 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. Methods: 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. Results: 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. Conclusions: 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.