Shared Decision Making Interventions for Deprescribing in Older Adults With Polypharmacy: A Scoping Review.

Background: Despite being integral to the deprescribing process, integration of shared decision making (SDM) into structured deprescribing interventions and its relation to patient outcomes remain understudied.

Methods: We conducted a scoping review of PubMed/MEDLINE, Embase, Scopus, and PsycInfo (through September 2023) with a medical librarian's guidance. Studies of SDM interventions for deprescribing in older adults with polypharmacy were included. Two independent reviewers performed screening and data abstraction. An iterative narrative synthesis was conducted to categorize the core functions (purposes) and forms (specific activities) of the identified interventions, along with their measured outcomes, including SDM-related outcomes.

Results: Among 5402 retrieved records, 14 studies of 12 distinct interventions met the inclusion criteria. Studies were published between 2017 and 2023 and described a pilot implementation (n = 3), randomized controlled trials (n = 9), or patient interviews assessing perceptions regarding interventions (n = 2). Most interventions (n = 9) evaluated were specific to the outpatient setting and led by primary care physicians (n = 6) or pharmacists (n = 3). Two (n = 2) were hospital-based, involving pharmacists with nurse practitioners or physicians, and one (n = 1) took place in nursing homes, led by nurses. Along with patient and medication identification (n = 12) and SDM (n = 12), common core functions included decision support (n = 7), care coordination (n = 5), coordinating follow-up and monitoring (n = 3), and family/caregiver involvement (n = 2). Only 4 studies explicitly mentioned an SDM framework, the Three-Talk Model (n = 2), AHRQ SHARE (n = 1), and the Collaborative Deliberation Model (n = 1); only three (n = 3) explicitly measured whether SDM occurred. The majority reported positive associations between the SDM interventions and medication use (n = 6) and deprescribing behaviors (n = 8).

Conclusions: There is substantial variability in how deprescribing interventions incorporate SDM. Most studies do not empirically measure SDM. While SDM is associated with improved satisfaction and process of care outcomes, evidence regarding the impact of SDM-informed deprescribing interventions and patient behavioral and health outcomes is inconclusive.