Facilitators of deprescribing
| Theme | Subtheme | TDF domain | Sample quotes |
| Deciding to deprescribe | Treatment burden | Intentions | “I’m glad those things have reduced.” P2 (practice 1) “We get quite a few people who are on a lot of medication, don't generally know why they take certain ones." HCP4 (practice 4) "And you do get a lot of them saying is there any of these that I could actually stop?” HCP2 (practice 4). |
| Shared decisions | Belief about capabilities Skills (ability) | “I am a great believer in shared decision making so I do spend a lot of my consultations around making sure that [the patient knows the reason for taking the medicine], because their concordance [adherence] will be very poor if they don’t understand why they are taking it and they need to understand the importance.” HCP3 (practice 1). | |
| Information and communication | Skills (interpersonal) Knowledge (procedural) | “…you’re doing something that they ultimately disagree with and you’re telling them that they can’t have something that they want, that’s the crux of the matter, but you also have to use your communication skills to explain why you’re doing that, why is it that you’re stopping this medication.” HCP3 (practice 3). | |
| Relationships | Trust in clinicians | Skills (interpersonal) | “So, I think for this lady I knew her, so I had a relationship with her which helps. And I think building that understanding and trust between us, so I think it was positive that we had trust…” HCP4 (practice 4) |
| Role of informal carers | Social Influences (social support) | “She can’t always take in what’s being said. If I had known that they were going to have her in to take her medication away I’d have gone with her, so that I could listen to the explanations that were being given to her to allay her worries.” IC1 (practice 4) | |
| Relationships (cont) | Multidisciplinary working | Social/professional role and identity (organisational commitment) Environmental context and resource (organisational culture) | “We’ve done a lot of deprescribing work here and it has been successful because we decided to involve the whole team. It would be no good if I sat here in a practice with six GPs and decided to improve my deprescribing because the other five GPs would be quietly sabotaging that without realising because we’re not working together. If we all change our deprescribing patterns, then we have a hope of really making (a) change.” HCP1 (practice 1) |
| Process of deprescribing | Gradual introduction | Skills (interpersonal) Memory, attention and decision processes Reinforcement Beliefs about consequences Goals Skills (competence) | “It was about a control thing, they start off with one thing, one little step, and then they came back and said how they felt about that step; for this case it was pregabalin, and I talked about how to reduce it and if actually they got side effects or if things got worse it was then to speak and actually go further; just wait a little while and then make your next step, and giving them back some of the control, so they felt in charge rather than me, and that always seems to work much better.” HCP2 (practice 3) |
| Process of deprescribing (cont) | Support, monitoring, follow-up | Goals (target setting) Knowledge (procedural) | “On that occasion [I received] as much [support] as I’d wanted, previously I’d discussed it [discontinuing aspirin] with [my GP] and with other practitioners at the health centre and been very, felt very supported.” P1 (practice 1) |
TDF, Theoretical Domains Framework.