Association Between Trust in Healthcare Providers and Readiness to Deprescribe in Older Adults: A Cross-Sectional Comparative Study in the United States and Japan.

BACKGROUND

Understanding how patient trust in healthcare providers is related to readiness to deprescribe is essential for optimizing deprescribing. This study examined this association among older adults with polypharmacy in the U.S. and Japan.

METHODS

We conducted cross-sectional surveys involving Japanese older adults receiving care from a community hospital and primary care clinic (Kawasaki City, n = 185) and American older adults recruited to a research registry within a university hospital system (Pittsburgh, n = 107). Cohorts were recruited using similar inclusion criteria (5+ prescriptions, community-resident, stable regimens, recent physician care, no dementia). Participants completed the 11-item Patient Perceptions of Deprescribing short form to assess readiness to deprescribe (range 6-30) and trust in healthcare providers (range 5-25).

RESULTS

Greater trust in providers was associated with lower readiness to deprescribe across both samples, with no significant interaction by location. A higher number of medications was associated with greater readiness. Although U.S. participants had higher readiness (16.7 vs. 15.4, p < 0.05) and trust (21.9 vs. 19.8, p < 0.001), the greater readiness observed among U.S. participants remained after adjustment for demographics and clinical characteristics (+2.45 points, p < 0.01).

CONCLUSIONS

Greater trust in healthcare providers was consistently associated with lower readiness to deprescribe across both samples. Although U.S. older adults demonstrated greater readiness to deprescribe compared to Japanese counterparts, the association between trust and motivation was similar across settings. This finding suggests that how trust functions in patient-provider relationships may be important for designing shared decision-making interventions for deprescribing.