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

Area of Science:

• Gerontology
• Palliative Care
• Clinical Pharmacy

Background:

• Home hospice medication management aims to control symptoms, reduce polypharmacy, and enhance patient quality of life.
• Aligning patient, family, and clinician goals with medication decisions is crucial but challenging.
• Existing tools often lack integration for goal-oriented medication management in hospice.

Purpose of the Study:

• To develop and assess the acceptability of a structured, interdisciplinary approach for Goal Concordant Prescribing (GCP) in home hospice.
• To create practical tools and training to facilitate communication and alignment around medication management based on care goals.
• To evaluate the perceived value and usability of the GCP program among hospice clinical staff.

Main Methods:

• Iterative development using human-centered design and adult learning principles, building on a prior deprescribing curriculum.
• Creation of clinician-facing tools: Person-Centered Medication Reconciliation worksheet, Goal Assessment and Priorities (GAP) Tool, and Conversation Guide.
• Acceptability testing through training sessions with hospice nursing and social work staff, followed by content analysis of feedback.

Main Results:

• Participants found framing deprescribing positively, linked to goals, to be an innovative and useful communication skill.
• The GCP training, GAP tool, and skill practice were deemed acceptable and valuable, adding value to clinical practice.
• Medication review aligned with prioritized goals was seen as innovative and useful without increasing workload.

Conclusions:

• Goal Concordant Prescribing (GCP) effectively aligns patient and family priorities with hospice medication management.
• This nurse-delivered intervention utilizes an interdisciplinary team and novel tools for improved communication.
• Pilot testing demonstrates high acceptability of GCP tools and training for facilitating medication management conversations.