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Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis

  • Domenica DisalvoEmail author
  • Tim Luckett
  • Alexandra Bennett
  • Patricia M. Davidson
  • Meera Agar
Pharmacoepidemiology and Prescription

Abstract

Purpose

This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate.

Methods

Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types.

Results

Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care.

Conclusion

Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.

Keywords

Decision-making Potentially inappropriate prescribing Long-term care Deprescribing Dementia Interdisciplinary collaboration 

Notes

Acknowledgements

The authors would like to thank all participants who participated in the focus groups as part of this study.

Authors’ contributions

DD contributed to the development of the research questions, conducted the search, analysed the articles and drafted the manuscript. TL and MA contributed to the development of research questions and analysis of data and helped to draft the manuscript. AB and PD contributed to the analysis of data. All authors contributed to and approved the final manuscript.

Funding information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. DD was supported by a UTS Doctoral Scholarship.

Compliance with ethical standards

Ethics approval was from the University of Technology Sydney (UTS) Human Research Ethics Committee (Approval Reference No. ETH16-0291). All participants gave written informed consent to participate.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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228_2019_2820_MOESM2_ESM.pdf (507 kb)
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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.IMPACCT – Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of HealthUniversity of Technology SydneySydneyAustralia
  2. 2.NSW Therapeutic Advisory GroupSydneyAustralia
  3. 3.School of Nursing, Johns Hopkins UniversityBaltimoreUSA
  4. 4.South Western Sydney Clinical School, University of New South WalesSydneyAustralia
  5. 5.Ingham Institute of Applied Medical ResearchSydneyAustralia

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