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Polypharmacy, a rising concern in the older adult population, is associated with significant risks, including adverse drug reactions and inappropriate medication use. Deprescribing, which is supported by effective communication between healthcare professionals and patients, has emerged as an important strategy to reduce potentially inappropriate medications. While numerous frameworks, guidelines, and tools exist to support healthcare professionals in deprescribing, many lack explicit integration of communication strategies, despite their critical role in shared decision-making and patient engagement.
The aim of this rapid review was to synthesize and describe the existing deprescribing frameworks, guidelines, and tools used by healthcare professionals, with a focus on how communication is represented within them. The secondary objective was to extract communication elements from each of the deprescribing frameworks, guidelines, and tools.
We used rapid review methodology recommended by the World Health Organization. The protocol was registered with the Open Science Framework and reported according to the PRISMA statement. CINAHL, Ovid Medline, and Scopus were searched from January 2003 to July 2024. Eligible studies focused on deprescribing frameworks, guidelines, or tools used by healthcare professionals caring for older adults (≥ 65 years). A qualitative synthesis of the evidence was conducted.
The search retrieved 5177 articles. After removing 1704 duplicates, 3473 citations were screened for eligibility. Of those, 343 were reviewed in full, and 18 were included in the final synthesis. We identified three frameworks, two guidelines, and seven tools. Frameworks such as A-TAPER, TAPER, and the 10-Step Conceptual Framework emphasized patient-centered care but varied in approach. Communication strategies, shared decision-making, active listening, feedback, communication adaptation, and encouraging participation were present but not explicit. Most frameworks targeted physicians and pharmacists, with minimal involvement of nurses.
Future deprescribing frameworks should explicitly integrate communication strategies and include nurses in their development. Building on these findings, our next step is to engage nurses to identify the most important communication characteristics for effective deprescribing conversations. These insights can guide the development of future frameworks, guidelines, and tools to support structured, patient-centered communication and improve deprescribing outcomes. This has important implications for clinical practice, education, and policy aimed at optimizing care for older adults.
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