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Measuring Quality of Life in Deprescribing Trials: A Scoping Review

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Abstract

Background

Quality of life (QoL) is an important outcome to capture in clinical trials evaluating deprescribing interventions.

Objective

We aimed to conduct a scoping review to examine how QoL has been measured in deprescribing trials among older people and identify potentially relevant QoL scales, to better inform QoL measurement in future deprescribing trials.

Methods

We searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials, Google Scholar, Epistemonikos, ClinicalTrials.gov, and reference lists of eligible studies (from inception to October 2023). We included randomized and non-randomized comparative studies with a control group that evaluated deprescribing and polypharmacy reduction interventions in people ≥ 65 years of age and measured QoL as an outcome. We also included studies describing the development and validation of QoL scales related to deprescribing, polypharmacy, or medication burden in adults ≥ 18 years of age. Two independent reviewers screened titles and abstracts, then full texts. Two independent reviewers extracted data from 25% of eligible studies in order to verify agreement, then a single reviewer extracted data from the remaining studies, which a second reviewer cross-checked. We critically appraised scales based on the COSMIN checklist.

Results

We retrieved 7290 articles, of which 52 were eligible for inclusion, including 44 deprescribing trials and eight scale development studies. From these studies, we found 21 scales that have been used in the context of deprescribing/polypharmacy (12 generic scales used in clinical trials and nine medication-specific scales). Variations of the generic EQ-5D were the most used scales. The measurement properties of scales for capturing changes in QoL from deprescribing were uncertain. Medication-specific QoL scales have not been employed in deprescribing clinical trials and thus, their performance in this context is also not clear.

Conclusions

Several existing QoL scales have been applied to the context of deprescribing/polypharmacy clinical trials, and new scales specific to the problem have been proposed. If deprescribing does impact QoL, our findings suggest it is uncertain whether existing QoL scales can practically and reliably capture such a change or whether any scale is best. However, this review compares various aspects of the scales that researchers and clinicians can consider in decisions about measuring QoL in deprescribing trials, and in planning future research.

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Open Science Framework: osf.io/aez6w.

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Authors and Affiliations

  1. Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, 317-2176 Health Sciences Mall, Vancouver, BC, V6T 2A1, Canada

    Wade Thompson, Douglas M. Salzwedel & Shahrzad Elmi

  2. Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Carina Lundby

  3. Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark

    Carina Lundby & Trine Graabæk

  4. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Adam Bleik, Harman Waring & Chris Xi

  5. School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland

    Jung Ah Hong & Frank Moriarty

  6. School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland

    Carmel Hughes

  7. Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada

    Emily G. McDonald

  8. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Jennifer Pruskowski

  9. Geriatric Research Education and Clinical Center, Pittsburgh Veteran Affairs Healthcare System, Pittsburgh, PA, USA

    Jennifer Pruskowski

  10. School of Healthcare, University of Leicester, Leicester, UK

    Sion Scott

  11. Louvain Drug Research Institute, Clinical Pharmacy Research Group, UCLouvain, Brussels, Belgium

    Anne Spinewine

  12. University of Colorado School of Medicine, Aurora, CO, USA

    Jean S. Kutner

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  1. Wade Thompson
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Corresponding author

Correspondence to Wade Thompson.

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Funding

This project is supported by funding from the United States Deprescribing Research Network (National Institute on Aging, Grant No. R24AG064025).

Conflict of interest

Wade Thompson has received grants from the US Deprescribing Network (National Institute on Aging), Canadian Institutes of Health Research, and Health Canada, for research on deprescribing. He also receives salary support from Michael Smith Health Research British Columbia. Wade Thompson, Carina Lundby, and Frank Moriarty were members of the Junior Investigator Intensive Program of the US Deprescribing Research Network, which is funded by the National Institute on Aging (R24AG064025). Jung Ah Hong contributed to this research while on placement supported by funds from the School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences. Adam Bleik, Harman Waring, Chris Xi, Carmel Hughes, Douglas M. Salzwedel, Emily G. McDonald, Jennifer Pruskowski, Sion Scott, Anne Spinewine, Jean S. Kutner, Trine Graabæk, and Shahrzad Elmi have no conflicts of interest that are directly relevant to the content of this article.

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Data are available on request from the authors.

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Author contributions

All authors meet the ICMJE authorship criteria and approve submission. The study was conceived by CL, WT, JP, SS, and FM. All authors contributed to the design of the study. WT, AB, CL, HW, JAH, CX, SE, and FM collected the data. All authors interpreted results. All authors contributed to drafting and critical revisions of the manuscript and approved the final submission.

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Thompson, W., Lundby, C., Bleik, A. et al. Measuring Quality of Life in Deprescribing Trials: A Scoping Review. Drugs Aging 41, 379–397 (2024). https://doi.org/10.1007/s40266-024-01113-0

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