A Conversation Aid for Climate Conscious Inhaler Prescribing.

Abstract

Climate conscious inhaler prescribing involves preferential selection of low carbon footprint devices while considering patient safety and preferences. What should be the content and design of inhaler conversation aids to facilitate climate-conscious prescribing for asthma and chronic obstructive pulmonary disease (COPD)? We developed a prototype for a web-based conversation aid, with tailored versions by medication class, age group, and disease (asthma/COPD). These provide information on inhaler contents, dosing, carbon footprint, cost, and safety considerations. We undertook an iterative rapid-cycle development process involving semi-structured interviews with family physicians, focus groups with patients with asthma and/or COPD, and an online survey, to optimize content and usability. After each round (interview and focus group), we identified emerging themes and critical changes and revised the tool accordingly. This process was repeated, with new participants, until pre-defined stopping criteria were met. Over five rounds, we recruited 25 patients (44% women) with asthma (n=10), COPD (n=9), and asthma/COPD overlap (n=6) and 5 family physicians. Serial changes included: simplifying language; clarifying cost, drug coverage, and dosing information; increasing the prominence of hover and safety messaging; and revising messaging to address inadvertent guilt or non-adherence among patients unable to switch to lower carbon footprint devices. Patients and physicians rated the tool highly on content, format, usability and impact, and endorsed that it would increase confidence in low carbon footprint inhaler selection. Engaging end-users throughout development provided insights into user priorities and supported the co-creation of conversation aids that aim to facilitate shared decision-making at the point-of-care.