ABSTRACT
Background
The use of behavior change models to conceptualize deprescribing provides an opportunity to explore the components of communication needed to overcome the many barriers to deprescribing.
Methods
Consensus development working group composed of care partner stakeholders and international experts in geriatrics, nursing, pharmacology, communication, and community outreach. The goal of the working group was to create a framework for the communication required among patients, care partners, and clinicians in the ambulatory setting to achieve the behavior of shared decision making about medication appropriateness and deprescribing. The COM-B (Capability, Opportunity, Motivation—Behavior) model provided an apt framework for characterizing deprescribing communication.
Results
Each component of the model requires specific communication skills, modes, and/or content. Capability requires clinician skills including elicitation of patient/care partner concerns and patient/care partner skills including self-efficacy for raising medication questions and concerns. This facilitates a shared understanding of constructs that inform communication content, including medication benefits and harms and the “how-to” of deprescribing. Opportunity requires the allocation of time during usual care or the creation of designated visits for communication. Motivation requires communication, such as audit and feedback directed at clinicians, and testimonials directed at patients and care partners, that encourages evaluation of medication appropriateness, increases awareness of potential problems, and overcomes clinical inertia.
Conclusions
The application of a behavioral health model to deprescribing communication highlights the importance of addressing capability, opportunity, and motivation in behavior change. Developing communication strategies that address these three components may enhance the effectiveness of deprescribing interventions.