The Healthcare Professionals Attitudes Towards Deprescribing (HATD) tool in older persons with multiple long-term chronic conditions and those on palliative care: A mixed methods study.

Abstract

To investigate healthcare professionals' (HCPs) perspectives towards deprescribing in older adults living with multiple long term conditions (MLTCs), including those at the end of life, using the validated Healthcare Professionals' Attitudes Towards Deprescribing (HATD) tool, and to explore implications for medication management in conditions such as diabetes, where polypharmacy is common. A cross-sectional online survey using the HATD questionnaire was disseminated across the United Kingdom from November 2023 to January 2024. Eligible participants were HCPs with experience managing older adults with MLTCs and/or those receiving end of life care. The tools 23-items covered five domains: concerns about deprescribing, perceived medication burden, organisational support, assurance in deprescribing decisions, and patient involvement. Quantitative data were summarised descriptively. Sixty-six HCPs participated (53 % doctors, 27 % pharmacists, 21 % allied health professionals). Many expressed discomfort in stopping medications initiated by specialists, particularly due to concerns about symptom recurrence or misattributed patient deterioration. Most recognised high medication burden, acknowledged that some drugs were no longer required, and agree deprescribing could improve quality of life. Barriers included lack of time, workload pressures, and insufficient training. Thematic analysis identified six key issues including perceived risk and fear of complains, absence of clear guidance, tensions between evidence based practice and multimorbidity, influence of specialist authority, resource constraints, and deprescribing as a potential routine practice. Significant barriers to deprescribing persist in UK practice, highlighting the need for clearer guidance, training, and multidisciplinary collaboration to optimise prescribing, including in chronic conditions such as diabetes.