Patient Perceptions of Deprescribing: Survey Development and Psychometric Assessment

Abstract

Background: Although clinicians ultimately decide when to discontinue (deprescribe) medications, patients' perspectives may guide the process.

Objectives: To develop a survey instrument that assesses patients' experience with and attitudes toward deprescribing.

Research design: We developed a questionnaire with established and newly created items. We used exploratory factor analysis and confirmatory factor analysis (EFA and CFA) to assess the psychometric properties.

Subjects: National sample of 1547 Veterans Affairs patients prescribed ≥5 medications.

Measures: In the EFA, percent variance, a scree plot, and conceptual coherence determined the number of factors. In the CFA, proposed factor structures were evaluated using standardized root mean square residual, root mean square error of approximation, and comparative fit index.

Results: Respondents (n=790; 51% response rate) were randomly assigned to equal derivation and validation groups. EFA yielded credible 4-factor and 5-factor models. The 4 factors were "Medication Concerns," "Provider Knowledge," "Interest in Stopping Medicines," and "Unimportance of Medicines." The 5-factor model added "Patient Involvement in Decision-Making." In the CFA, a modified 5-factor model, with 2 items with marginal loadings moved based upon conceptual fit, had an standardized root mean square residual of 0.06, an RMSEA of 0.07, and a CFI of 0.91. The new scales demonstrated internal consistency reliability, with Cronbach α's of: Concerns, 0.82; Provider Knowledge, 0.86; Interest, 0.77; Involvement, 0.61; and Unimportance, 0.70.

Conclusions: The Patient Perceptions of Deprescribing questionnaire is a novel, multidimensional instrument to measure patients' attitudes and experiences related to medication discontinuation that can be used to determine how to best involve patients in deprescribing decisions.