Human-Centered Design Development and Acceptability Testing of a Goal Concordant Prescribing Program in Hospice

Home hospice medication management ideally addresses symptoms, reduces unnecessary medication use, and optimizes quality of life. Grounding decisions in goals of care is critical. How to ascertain and align patients', families', and clinicians' goals for medication management remains challenging. To describe the iterative development and acceptability testing of a structured, interdisciplinary approach to goal concordant prescribing (GCP). We started with a previously developed deprescribing curriculum that followed a three-step process: review, align, and simplify. We utilized human-centered design and adult learning experts to translate the existing curriculum into tools and training that addressed gaps identified in an environmental scan (see Supplementary Data for a review of existing tools). Weekly multidisciplinary design team meetings revealed the need for tools to facilitate medication-focused and goal-oriented communication. The revised GCP program includes three clinician-facing tools: (1) GCP Person-Centered Medication Reconciliation worksheet, (2) Goal Assessment and Priorities (GAP) Tool, and (3) GCP Conversation Guide. Acceptability was tested with nursing and social work staff at a not-for-profit hospice who completed two 2-hour GCP training sessions. We used a content analytic approach to evaluate written and verbal feedback that was collected after each session. Participants felt that framing deprescribing in positivist language that connected medication changes to goals was innovative and a useful conversation skill. Participants also felt that GCP training was acceptable, the GAP tool and skill practice were useful, the GCP Program added value to clinical practice, and medication review in relation to prioritized goals was innovative and useful without adding to clinician workload. GCP supports alignment of patient and family priorities with medication management. This nurse-delivered intervention involves the interdisciplinary team and employs novel tools. Pilot testing indicates GCP tool and training acceptability to facilitate medication management conversations.