The Deprescribing Conversation Project (QI822)

Abstract

•Describe the attitudes and perceptions of hospice nurses toward deprescribing conversations before and after viewing the pharmacist-created deprescribing videos.•Recognize the potential impact of nurse-pharmacist collaboration in deprescribing conversations. Nurses are frequently frontline providers for patients nearing the end of life and are often expected to deliver precise communication regarding futile treatments and unnecessary medications to patients and families. These conversations can be challenging for nurses as well as emotional for patients and families. Pharmacists with their unique knowledge of pharmacotherapy, including medication time-to-benefit and medication risk-to-benefit profiles, may be able to provide nurses with the “words” for difficult deprescribing conversations. The purpose of this project was to enhance hospice nurses’ knowledge and comfort with deprescribing conversations by providing a structured dialogue for discussing the benefits and burdens of drug therapy in patients with limited life expectancies. Two patient-nurse vignettes were scripted by a hospice pharmacist and filmed using student pharmacist actors. Each video captured a common deprescribing situation—cholinesterase inhibitor therapy in advanced dementia and inhaler polypharmacy in chronic lung disease. Using Camtasia® video editing software, text overlay was created to highlight a step-by-step approach for initiating deprescribing conversations and to reinforce various communication strategies. Hospices nurses from two hospices viewed these videos and completed a pre- and post-survey regarding their perceptions and comfort with deprescribing conversations. Six nurses completed both the pre- and post-surveys. After viewing the videos, all nurses reported increased comfort with deprescribing conversations and indicated that they planned to incorporate communication strategies from the videos into their own practices. Five of the six nurses indicated that they were more likely to engage in deprescribing conversations with patients and families after viewing the videos. A structured approach to deprescribing conversations—modeled by pharmacists and viewed by nurses—improved nurses’ comfort level with and attitudes toward deprescribing conversations.