Priorities Aligned Deprescribing for Persons Living with Dementia and their Caregivers
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Project Summary Title: Priorities Aligned Deprescribing for Persons Living with Dementia and their Caregivers Persons living with dementia (PlwD) have a significant burden from multiple chronic conditions and overmedication, and particularly benefit from deprescribing to reduce polypharmacy. Deprescribing is a systematic process to reduce medications with unacceptable harms or lack ofbenefit in the context of a patient’s overall status and goals and preferences for care. Patient Priorities Care (PPC) is an evidence- based approach to identify outcome goals and care preferences (health priorities) and align care to meet those priorities. Deprescribing is targeted towards therapies that are misaligned with priorities. Less is known about how PPC works in thecontext of clinician, caregiver, and persons living with dementia (PlwD). Aligning all three goals could be crucial for successful, safe deprescribing in the setting of dementia. To facilitate the adaptation of the PPC approach to the context of deprescribing for PlwD, we will address the following research questions: Q1) How does the identification of patient priorities facilitate deprescribing for PlwD and their caregivers? Q2) How are blended (PlwD and caregiver) outcome goals and caregivers’ care preferences interpreted and used by clinicians? Q3) How do clinicians make treatment decisions to reduce or stop medications based on the misalignment of drugs with priorities that include blended outcome goals and caregiver preferences? Q4) What are the adverse drug withdrawal events (ADWEs) that occur from deprescribing medications based on patient priorities aligned care decisions? To answer these questions, we propose the following study aims: Aim 1: Conduct a pilot randomized clinical trialwith 50 PlwD and caregiver dyads and their clinicians to compare the PPC approach and usual care to identify differences in post-encounter medication changes, treatment burden, and shared decision making. We will also compare differences in medication changes based on documentation of care preferences and goals by patients, caregivers, or both. (Q1) Aim 2: For PPC participants, we will conduct cognitive-task-analyses with primary providers to understandtheir sense-making and communication approaches related to deprescribing decisions in relation to the identified health priorities. (Q2, Q3) Aim 3: For all participants, we will conduct a post-encounter follow up televisit to identify and categorize ADWEs. (Q4) The study results willinform the processes of how clinicians make decisions about medication misalignment with priorities and the extent to which those decisions result in ADWE. Findings will also provide feasibility and effect size data to inform a larger clinical trial of Patient Priorities Care, testing itseffectiveness and safety for deprescribing for PlwD and their caregivers.
