Abstract
BackgroundGiven uncertainty surrounding benefits and harms, shifts in patient health status, and changing patient goals and preferences, statin deprescribing may be considered in some older people. This decision should be carefully discussed between GPs and patients.AimTo explore how GPs discuss deprescribing of statins with their older patients.Design & settingA qualitative study was undertaken using face-to-face, semi-structured interviews with Danish GPs from the regions of Southern Demark and Zealand.MethodThe GP participants belonged to group practices and were identified from personal networks and snowballing. The interviews lasted approximately 30 minutes and were conducted in English. They were analysed using systematic text condensation.ResultsA total of 11 GPs were interviewed and three themes were identified. (1) Reason for initiating a discussion: statin deprescribing mainly came up when GPs reviewed medication lists. There were differences between GPs regarding when or if they brought up deprescribing. (2) Discussion topics: GPs often discussed their interpretation of evidence surrounding statin use in older people. There were differences in how and if GPs discussed patient preferences. GPs viewed uncertainty and life expectancy as difficult to discuss. (3) Depth of discussion: the perceived level of patient engagement, and clinical context, could influence the extent of discussion.ConclusionGPs identified a range of topics that could be discussed with patients surrounding statin deprescribing. The depth and content of discussions varied according to the situation, and between GPs. Challenges may exist in communicating around certain topics, such as uncertainty and life expectancy. Further understanding of how to best communicate around challenging topics, and development of structured frameworks, may help facilitate statin deprescribing discussions. Identifying what patients think is important to discuss would provide necessary insight to promote quality discussions and shared understanding of the decision.
Highlights
Statins are commonly used in older people.[1]
(2) Discussion topics: GPs often discussed their interpretation of evidence surrounding statin use in older people
GPs identified a range of topics that could be discussed with patients surrounding statin deprescribing
Summary
Statins are commonly used in older people.[1]. While statins may have been initiated with a compelling and evidence-based indication, the balance of benefit and harm of statins can shift as people age,[2] just as patients’ goals of care and treatment preferences can change.[3]. Established decision-m aking frameworks[8,9,10] suggest that medication decisions be informed; consistent with patient values, preferences, and goals; and shared between the patient and clinician.[11] Patients and prescribers should have a common understanding of options that exist; knowledge of benefits, harms, and uncertainties for options; and values and preferences of the patient.[9,10,12] As such, medication decisions, including statin deprescribing, require careful discussion between patients and prescribers around these various considerations. The study aimed to explore how GPs discuss statin deprescribing in their older patients. Given uncertainty surrounding benefits and harms, shifts in patient health status, and changing patient goals and preferences, statin deprescribing may be considered in some older people. This decision should be carefully discussed between GPs and patients
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