What do clinical practice guidelines say about deprescribing? A scoping review

Area of Science:

• Pharmacology
• Evidence-based medicine
• Health services research

Background:

• Deprescribing, the reduction or cessation of medication, is crucial for appropriate prescribing.
• The prevalence and nature of deprescribing recommendations in clinical practice guidelines remain unclear.

Purpose of the Study:

• To identify clinical practice guidelines containing deprescribing recommendations.
• To qualitatively analyze the content and format of these recommendations.
• To estimate the proportion of guidelines that include deprescribing advice.

Main Methods:

• A scoping review searched bibliographic databases and Google (2012-2022) and guideline registries (2017-2023).
• Two reviewers screened records; a 10% sample of registries was assessed for proportion estimation.
• Content analysis and the SHeLL Health Literacy Editor tool examined recommendation characteristics and readability.

Main Results:

• 80 guidelines with 316 deprescribing recommendations were identified, showing variability in format and terminology.
• Most guidelines specified who, what, and when/why to deprescribe, but only 58% detailed how.
• Approximately 29% of guidelines from the registry sample contained deprescribing recommendations.

Conclusions:

• Deprescribing recommendations are increasingly included in guidelines, yet often lack actionable 'how-to' guidance.
• The absence of clear implementation instructions may hinder clinical practice.
• Developing a co-designed template or best practice guide is recommended to improve deprescribing recommendation utility.