Drugs & Aging

, Volume 33, Issue 12, pp 913–928 | Cite as

Development and Validation of the Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire: Versions for Older Adults and Caregivers

  • Emily ReeveEmail author
  • Lee-Fay Low
  • Sepehr Shakib
  • Sarah N. Hilmer
Original Research Article



Knowledge of consumer (patient and caregiver) attitudes is essential for conducting medication optimization in practice.


The aim of this study was to develop and validate a questionnaire to capture older adults’ and caregivers’ beliefs and attitudes towards deprescribing.


The previously validated Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was expanded based on literature review, expert opinion and focus groups, and a caregivers’ version was developed. The revised questionnaire was piloted and then distributed for self-completion to older adults (≥65 years of age), taking at least one regular medication and caregivers of older adults. Psychometric validity and reliability were examined. Responses to questions that were identified to group into a specific factor were combined to produce a score.


A total of 383 consumer questionnaires and 200 caregiver questionnaires were completed and included in analysis. Exploratory factor analysis revealed four factors in both versions of the questionnaire (with four to five questions retained in each factor). The factors relate to the perceived burden of medication taking, belief in appropriateness of medication use (harms and benefits), concerns about stopping the medication, and level of involvement/knowledge of medications. Internal consistency of all factors was acceptable with Cronbach’s alpha >0.6. In both the older adults’ and caregivers’ versions, the burden score was inversely associated with the appropriateness score (p < 0.001 both versions). Factor scores between administration times (test–retest reliability) were statistically significantly correlated (p = 0.000), with gamma values ranging between 0.57 and 0.89.


The revised PATD questionnaire had acceptable validity and reliability. This newly validated questionnaire may provide insight into individuals’ willingness for/barriers to deprescribing, with applications in practice and research.


Exploratory Factor Analysis Factor Score Electronic Supplementary Table Global Question Medication Withdrawal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors express their gratitude to all participants who completed the questionnaires and to the experts who contributed to item generation and content validity assessment. We also appreciate the contribution of the organizations and many individuals who assisted with the distribution and advertising of the questionnaires, in particular Tara Quirke, Catriona Lorang and Jan van Emden.

Compliance with Ethical Standards


This research was funded by the National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre (CDPC). The CDPC receives support from the NHMRC and funding partners, including HammondCare, Alzheimer’s Australia, Brightwater Care Group and Helping Hand Aged Care. Project funding from the CDPC is delivered through the University of Sydney, Aging and Pharmacology Group. The funding bodies had a role in the study concept, but no role in the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication. Funding partners HammondCare, Helping Hand Aged Care and Alzheimer’s Australia had a role in the distribution of the questionnaires and advertising of the online version. Lee-Fay Low is funded by an NHRMC Career Development Fellowship.

Conflicts of interest

Emily Reeve, Lee-Fay Low, Sepehr Shakib and Sarah Hilmer declare that they have no conflicts of interest relevant to the content of this article.

Supplementary material

40266_2016_410_MOESM1_ESM.docx (67 kb)
Supplementary material 1 (DOCX 66 kb)
40266_2016_410_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 16 kb)


  1. 1.
    Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging definition of “deprescribing” with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254–68.CrossRefPubMedGoogle Scholar
  2. 2.
    Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.CrossRefPubMedGoogle Scholar
  3. 3.
    Opondo D, Eslami S, Visscher S, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS One. 2012;7(8):e43617.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Anderson K, Freeman C, Stowasser D, et al. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4:e006544.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Turner JP, Edwards S, Stanners M, et al. What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open. 2016;6(3):e009781.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    de Vries TPGM, Henning RH, Hogerzeil HV, et al. Guide to good prescribing. Geneva: World Health Organization; 1995.Google Scholar
  7. 7.
    Reeve E, Shakib S, Hendrix I, et al. Review of deprescribing processes and development of an evidence based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014;78(4):738–47.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;353(i2893).Google Scholar
  9. 9.
    Griffin SJ, Kinmonth A-L, Veltman MW, et al. Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004;2(6):595–608.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kitson A, Marshall A, Bassett K, et al. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs. 2013;69(1):4–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Reeve E, Wiese MD, Hendrix I, et al. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc. 2013;61(9):1508–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Williams M, Pulliam C, Hunter R, et al. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004;52(1):93–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Reeve E, To J, Hendrix I, et al. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807.CrossRefPubMedGoogle Scholar
  15. 15.
    Bogardus ST, Bradley EH, Williams CS, et al. Achieving goals in geriatric assessment: role of caregiver agreement and adherence to recommendations. J Am Geriatr Soc. 2004;52(1):99–105.CrossRefPubMedGoogle Scholar
  16. 16.
    Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. Oxford: Oxford University Press; 2014.CrossRefGoogle Scholar
  17. 17.
    Reeve E, Low L-F, Hilmer SN. Beliefs and attitudes of older adults and carers about deprescribing of medications. Br J Gen Pract. 2016;66(649):e552–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Collins D. Pretesting survey instruments: an overview of cognitive methods. Qual Life Res. 2003;12(3):229–38.CrossRefPubMedGoogle Scholar
  19. 19.
    Tudiver F. Developing self-report measures in health care. In: Vingerhoets A, editor. Assessment in behavioural medicine. Hove: Routledge; 2001.Google Scholar
  20. 20.
    Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1–24.CrossRefGoogle Scholar
  21. 21.
    Dugan E, Trachtenberg F, Hall MA. Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Serv Res. 2005;5(1):64.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Thompson B. Exploratory and confirmatory factor analysis: understanding concepts and applications. Washington, DC: American Psychological Association; 2004.CrossRefGoogle Scholar
  23. 23.
    Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28(4):563–75.CrossRefGoogle Scholar
  24. 24.
    Kusljic S, Manias E, Tran B, et al. Enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. Aging Male. 2013;16(3):112–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Ellenbecker CH, Frazier SC, Verney S. Nurses’ observations and experiences of problems and adverse effects of medication management in home care. Geriatr Nurs. 2004;25(3):164–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Tudball J. Living with multiple medicines. 2014. Accessed 4 Jul 2014.
  27. 27.
    Campbell NL, Boustani MA, Skopelja EN, et al. Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. Am J Geriatr Pharmacother. 2012;10(3):165–77.CrossRefPubMedGoogle Scholar
  28. 28.
    Volume CI, Burback LM, Farris KB. Reassessing the MAI: elderly people’s opinions about medication appropriateness. Int J Pharm Pract. 1999;7(3):129–37.CrossRefGoogle Scholar
  29. 29.
    Travis SS, Bernard MA, McAuley WJ, et al. Development of the family caregiver medication administration hassles scale. Gerontologist. 2003;43(3):360–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Blalock SJ, Patel RA. Drug therapy concerns questionnaire: initial development and refinement. J Am Pharmacist Assoc. 2004;45(2):160–9.CrossRefGoogle Scholar
  31. 31.
    Marshall IJ, Wolfe CD, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012;345:e3953.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Sacajiu G, Raveis VH, Selwyn P. Patients and family care givers’ experiences around highly active antiretroviral therapy (HAART). AIDS Care. 2009;21(12):1528–36.CrossRefPubMedGoogle Scholar
  33. 33.
    Blass DM. The physician–patient relationship in dementia care. Neurotherapeutics. 2007;4(3):545–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Parsons C, Hughes CM, Passmore AP, et al. Withholding, discontinuing and withdrawing medications in dementia patients at the end of life. Drugs Aging. 2010;27(6):435–49.CrossRefPubMedGoogle Scholar
  35. 35.
    Popejoy L. Health-related decision-making by older adults and their families: how clinicians can help. J Gerontol Nurs. 2005;31(9):12–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Gale C, Baldwin L, Staples V, et al. An exploration of the experience of mental health service users when they decide they would like to change or withdraw from prescribed medications. J Psychiatr Mental Health Nurs. 2012;19(10):853–9.CrossRefGoogle Scholar
  37. 37.
    Garavalia L, Ho PM, Garavalia B, et al. Clinician–patient discord: exploring differences in perspectives for discontinuing clopidogrel. Eur J Cardiovasc Nurs. 2011;10(1):50–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Robinson JP, Shaver PR, Wrightsman LS. Criteria for scale selection and evaluation. In: Robinson JP, Shaver PR, Wrightsman LS, editors. Measures of personality and social psychological attitudes. Oxford: Elsevier; 1991.Google Scholar
  39. 39.
    Jakobsson U, Westergren A. Statistical methods for assessing agreement for ordinal data. Scand J Caring Sci. 2005;19(4):427–31.CrossRefPubMedGoogle Scholar
  40. 40.
    Qi K, Reeve E, Hilmer S, et al. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm. 2015;37(5):949–57.CrossRefPubMedGoogle Scholar
  41. 41.
    Galazzi A, Lusignani M, Chiarelli MT, et al. Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy. Int J Clin Pharm. 2016;38(2):454–61.CrossRefPubMedGoogle Scholar
  42. 42.
    Gliem JA, Gliem RR. Calculating, interpreting, and reporting Cronbach’s alpha reliability coefficient for Likert-type scales. Midwest Research-to-Practice Conference in Adult, Continuing, and Community Education; 8–10 Oct 2003: Columbus, OH.Google Scholar
  43. 43.
    Australian Bureau of Statistics. Survey of disability, ageing and carers: summary of findings. 2012. Accessed 10 Apr 2016.
  44. 44.
    Reeve E, Bell S, Hilmer S. Barriers to optimising prescribing and deprescribing in older adults with dementia: a narrative review. Curr Clin Pharmacol. 2014;10(3):168–77.CrossRefGoogle Scholar
  45. 45.
    Linsky A, Simon SR, Bokhour B. Patient perceptions of proactive medication discontinuation. Patient Educ Couns. 2015;98(2):220–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Fried TR, O’Leary J, Van Ness P, et al. Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment. J Am Geriatr Soc. 2007;55(7):1007–14.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    George D, Mallery P. SPSS for Windows step by step: a simple guide and reference, 11.0 update. Boston: Allyn and Bacon; 2003.Google Scholar
  48. 48.
    Kline P. The new psychometrics: science, psychology and measurement. London: Routledge; 2014.Google Scholar
  49. 49.
    Moen J, Bohm A, Tillenius T, et al. “I don’t know how many of these [medicines] are necessary”—a focus group study among elderly users of multiple medicines. Patient Educ Couns. 2009;74(2):135–41.CrossRefPubMedGoogle Scholar
  50. 50.
    Australian Institute of Health and Welfare. Demographics of older Australians. 2016. Accessed 19 Sep 2016.
  51. 51.
    Hubbard RE, Peel NM, Scott IA, et al. Polypharmacy among inpatients aged 70 years or older in Australia. Med J Aust. 2015;202(7):373–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Atkinson MJ, Sinha A, Hass SL, et al. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes. 2004;2(1):12.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical SchoolUniversity of SydneySydneyAustralia
  2. 2.Geriatric Medicine Research, Faculty of Medicine, Queen Elizabeth II Health Sciences CentreDalhousie University and Nova Scotia Health AuthorityHalifaxCanada
  3. 3.Faculty of Health SciencesUniversity of SydneySydneyAustralia
  4. 4.Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideAustralia
  5. 5.Department of Clinical Pharmacology, Faculty of Health Science, School of MedicineUniversity of AdelaideAdelaideAustralia
  6. 6.Departments of Aged Care and Clinical PharmacologyRoyal North Shore HospitalSt LeonardsAustralia

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