Factors influencing deprescribing in community-dwelling patients with palliative needs in primary care: A qualitative systematic review.

Abstract

Patients with palliative needs often use potentially inappropriate medications, leading to adverse health outcomes. Deprescribing remains poorly enacted in primary care. Understanding the factors influencing deprescribing is essential for successful implementation into clinical practice. To explore factors influencing deprescribing in community-dwelling patients with palliative needs in primary care from the perspectives of patients, their caregivers and primary healthcare practitioners. Qualitative systematic review using thematic synthesis, registered in PROSPERO (CRD42024620219). MEDLINE, Embase, CINAHL, and PsycINFO were searched from 2000 to January 2025, directed by the Palliative cAre Literature rEview iTeraTive mEthod (PALETTE) framework. Studies were included if they reported on independently living adults with palliative care needs. 23 studies were included. Four themes were established: (i) initial stance towards deprescribing: shaped by values, general perceptions of (de)prescribing, and competencies. This served as the premise for (ii) the deprescribing conversation: characterised by an individualised deliberation, shared decision-making, and tailored communication and practical strategies. During this conversation, (de)prescribing was reconsidered in the context of the individual patient, informing final decisions. Whether and how these conversations occurred was dependent on (iii) organisational factors, including systematic work processes and interprofessional collaboration. All factors operated within and interacted with (iv) the context of care, containing system-level prerequisites. Deprescribing in community-dwelling patients with palliative needs in primary care can be optimised by employing a multidimensional strategy that includes patient-centredness, shared decision-making, education, collaboration within the multidisciplinary care team, and systematic work processes, ultimately aiming to improve quality of life.