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Patient Values and Preferences Surrounding Proton Pump Inhibitor Use: A Scoping Review

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Abstract

Background

Proton pump inhibitors (PPIs) treat various upper gastrointestinal (GI) diseases. Around 50% of patients may remain on PPIs long-term without ongoing need. Eligible patients should be offered the choice of continuing their PPI or trying to reduce/stop their PPI (deprescribing), a choice dependent on values and preferences.

Objectives

Our objective was to systematically scope the available evidence on patient values and preferences surrounding continued PPI treatment and/or the decision to try a reduction in their PPI. We searched the MEDLINE, Embase, and Cochrane Library databases and the grey literature as of 9 August 2016 for studies of any design examining patient values and preferences toward PPI treatment and/or deprescribing. We included patients aged ≥18 years taking PPIs for upper GI diseases.

Results

We located 12 eligible studies (seven surveys, four qualitative studies, one randomized controlled trial). One study only examined values and preferences towards reducing PPI use, five studies looked only at PPI treatment (initiation/continuation), four studies assessed both PPI treatment and reduction, and two studies evaluated PPI treatment and switching (to alternative PPIs). Patients value symptom control highly and worry about symptoms returning if the PPI is reduced. They are encouraged to consider reducing their PPI if a clinician provides advice and education. All five studies that examined reducing PPI use suggest patients should understand the rationale for considering continuation versus deprescribing of PPIs and should know what to expect from deprescribing. Patients are encouraged by knowing they can return to their previous dose if necessary. Our results were limited by the small sizes of studies and the heterogeneous populations.

Conclusion

Patients are willing to discuss the option of continuing PPI use or trying to reduce their PPI; however, a range of attitudes exist. The results suggest that reducing a PPI is a preference-sensitive decision. Therefore, patient attitudes should be elicited and incorporated into shared decision making surrounding the decision to continue or try deprescribing a PPI, and structured tools will be helpful to encourage this.

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Author information

Authors and Affiliations

  1. School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada

    Wade Thompson, Cody Black, Vivian Welch, Lise M. Bjerre & Peter Tugwell

  2. Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada

    Wade Thompson, Cody Black, Vivian Welch, Barbara Farrell, Lise M. Bjerre & Peter Tugwell

  3. Centre for Global Health, Ottawa, ON, Canada

    Vivian Welch & Peter Tugwell

  4. Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada

    Barbara Farrell & Lise M. Bjerre

  5. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Peter Tugwell

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  1. Wade Thompson
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Corresponding author

Correspondence to Wade Thompson.

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Author contributions

WT conceived this scoping review and collected data, along with CB. WT synthesized and analyzed data with critical input from CB, VW, BF, LMB, and PT. WT drafted the manuscript and CB, VW, BF, LMB, and PT provided critical revisions. All authors approved the final version.

Funding

No funding was received to complete this study or assist with preparation of the manuscript.

Conflict of interest

All authors have completed a conflict of interest form and declare no support from any organization for the submitted work. WT reports an MSc stipend from the Government of Ontario. LMB reports personal fees and non-financial support from the Department of Family Medicine, University of Ottawa; non-financial support from Bruyère Research Institute; grants from the Canadian Institutes for Health Research (CIHR); and grants from the Ministry of Health and Long-Term Care of Ontario outside the submitted work. BF reports grants from the Government of Ontario and the CIHR, and non-financial support from Bruyere Research Institute during the conduct of the study. The authors declare no other relationships or activities that could appear to have influenced the submitted work.

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Thompson, W., Black, C., Welch, V. et al. Patient Values and Preferences Surrounding Proton Pump Inhibitor Use: A Scoping Review. Patient 11, 17–28 (2018). https://doi.org/10.1007/s40271-017-0258-4

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