Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia

• DOI: 10.1001/jamanetworkopen.2023.36728
• Publication Date: 2023-10-03T15:05:53Z
• Authors: Jonathan D. Norton; Chan Zeng; Elizabeth A. Bayliss; Susan M. Shetterly; Nicole Williams; Emily Reeve; Matthew K. Wynia; Ariel R. Green; Melanie L. Drace; Kathy S. Gleason; Orla C. Sheehan; Cynthia M. Boyd
• Keywords: Deprescribing; Beers Criteria; Specialty; Hospital medicine; Cross-sectional study

Importance Physicians endorse deprescribing of risky or unnecessary medications for older adults (aged ≥65 years) with dementia, but there is a lack information on what influences decisions to deprescribe in this population. Objective To understand how physicians make moderate dementia and ethical pragmatic concerns influencing those decisions. Design, Setting, Participants A cross-sectional national mailed survey study random sample 3000 primary care from the American Medical Association Physician Masterfile who was conducted January 15 December 31, 2021. Main Outcomes Measures The randomized participants consider 2 clinical scenarios which physician may decide medication dementia: 1 could cause an adverse drug event if continued other no evidence benefit. ranked 9 factors related possible through best-worst scaling methods (from greatest barrier smallest deprescribing). Conditional logit regression quantified relative importance each factor as deprescribing. Results total 890 (35.0%) returned surveys; 511 (57.4%) were male, mean (SD) years since graduation 26.0 (11.7). Most had specialty family practice (50.4% [449 890]) internal medicine (43.5% [387 890]). 689 surveys sufficiently complete analyze. In both scenarios, barriers (1) patient reporting symptomatic benefit (beneficence autonomy) (2) having been prescribed by another (autonomy nonmaleficence). least influential ease paying (justice). Conclusions Relevance Findings suggests that understanding aspects decision-making can inform clinician education about management dementia.