Journal of general internal medicine · 2026
Designing Implementable Deprescribing Recommendations: A Qualitative Study of Healthcare Professional Perspectives.
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Langford Aili V, Liau Shin J, Loh Sheryn, Farrell Barbara, Thompson Wade, Pollock Danielle, Moriarty Frank, Gnjidic Danijela, Ailabouni Nagham J, Reeve Emily
Аннотация
BACKGROUND: Clinical guidelines routinely contain recommendations about initiating therapies, but less frequently address deprescribing (medication dose reduction or discontinuation). Routine integration of deprescribing recommendations into guidelines may enhance their reach, adoption, and impact.
OBJECTIVE: To elicit the perspectives of Australian healthcare professionals on the preferred content, language, and format of deprescribing recommendations for inclusion in clinical guidelines.
DESIGN: A qualitative study using semi-structured interviews.
PARTICIPANTS: Twenty-four medical doctors, pharmacists, and registered nurses were interviewed.
APPROACH: Open-ended questions on what constitutes a complete, clear, and implementable deprescribing recommendation were posed. Participants were asked to identify features of example deprescribing recommendations that they found to be useful or not, justifying their reasoning. A thematic framework analysis was conducted using the Guideline Language and Format Instrument (GLAFI).
KEY RESULTS: Three overarching themes were generated. Theme 1-a higher content and evidentiary threshold for deprescribing recommendations compared to prescribing recommendations-reflected participants' perceptions that deprescribing is more complex than medication initiation. Consequently, a higher standard for what constitutes an acceptable, feasible, and clinically useful deprescribing recommendation was described. Theme 2-balancing clarity and comprehensiveness-explored the tension between participants' desire for succinct and uncomplicated recommendations, and their want for detailed and comprehensive deprescribing instruction. Theme 3-optimizing the location of deprescribing recommendations-explored differing preferences on the location of deprescribing recommendations, with some participants favoring co-location with prescribing recommendations to promote proactive deprescribing, and others preferring a standalone section to enable inclusion of broader deprescribing principles and strategies, beyond medication-specific advice.
CONCLUSIONS: Healthcare professionals considered the content, language, and format of deprescribing recommendations to be intrinsic to implementability. Deprescribing-specific factors, particularly the operational complexity of how to deprescribe and risk-framing considerations, extended beyond GLAFI's principles. These findings highlight opportunities to improve future deprescribing recommendations and to strengthen implementability frameworks for de-implementation.
OBJECTIVE: To elicit the perspectives of Australian healthcare professionals on the preferred content, language, and format of deprescribing recommendations for inclusion in clinical guidelines.
DESIGN: A qualitative study using semi-structured interviews.
PARTICIPANTS: Twenty-four medical doctors, pharmacists, and registered nurses were interviewed.
APPROACH: Open-ended questions on what constitutes a complete, clear, and implementable deprescribing recommendation were posed. Participants were asked to identify features of example deprescribing recommendations that they found to be useful or not, justifying their reasoning. A thematic framework analysis was conducted using the Guideline Language and Format Instrument (GLAFI).
KEY RESULTS: Three overarching themes were generated. Theme 1-a higher content and evidentiary threshold for deprescribing recommendations compared to prescribing recommendations-reflected participants' perceptions that deprescribing is more complex than medication initiation. Consequently, a higher standard for what constitutes an acceptable, feasible, and clinically useful deprescribing recommendation was described. Theme 2-balancing clarity and comprehensiveness-explored the tension between participants' desire for succinct and uncomplicated recommendations, and their want for detailed and comprehensive deprescribing instruction. Theme 3-optimizing the location of deprescribing recommendations-explored differing preferences on the location of deprescribing recommendations, with some participants favoring co-location with prescribing recommendations to promote proactive deprescribing, and others preferring a standalone section to enable inclusion of broader deprescribing principles and strategies, beyond medication-specific advice.
CONCLUSIONS: Healthcare professionals considered the content, language, and format of deprescribing recommendations to be intrinsic to implementability. Deprescribing-specific factors, particularly the operational complexity of how to deprescribe and risk-framing considerations, extended beyond GLAFI's principles. These findings highlight opportunities to improve future deprescribing recommendations and to strengthen implementability frameworks for de-implementation.