The CoDe/ETHIC-Talk: A theory-informed intervention to support ethical deprescribing in hospice care

Polypharmacy is common in hospice care and contributes to treatment burden and misaligned goals. Although deprescribing is essential, practices remain inconsistent and lack ethical responsiveness, particularly in addressing emotional readiness.

To develop a theory-informed framework that integrates ethical reasoning and emotionally intelligent communication to support deprescribing in hospice care.

Fifteen physicians, nurses, and pharmacists from a major hospice service in Jordan participated in semi-structured interviews guided by the Theoretical Domains Framework Version 2 (TDFv2). Data were thematically analyzed, identified deprescribing determinants (barriers and enablers) were mapped to TDFv2 domains, prioritized, and linked to Behavior Change Techniques (BCTs). Determinants were organized into a logic model and refined through stakeholder feedback.

Ten key determinants were mapped to seven prioritized TDFv2 domains: inconsistent awareness and application of deprescribing guidance (Knowledge); reliance on clinical judgment and team consensus (Social influences); fear, abandonment, and anxiety linked to deprescribing (Emotion); need for ethical framing through empathetic communication (Emotion); patient-centered, autonomy-based justifications (Beliefs about consequences); ethical uncertainty in complex cases (Social/professional role and identity); and system-level gaps such as lack of formal guidance and need for flexible protocols (Environmental context and resources; Memory, attention, and decision processes). These informed the development of a Framework, comprising: Contextualized Deprescribing (CoDe), which embeds electronic prompts and care pathways; and Ethical Therapeutic Insight for Compassionate Communication (ETHIC-Talk), which delivers communication scripts and reframing strategies.

Pending feasibility evaluation, the CoDe/ETHIC-Talk Framework could provide a structured, context-sensitive approach to deprescribing that integrates clinical support with ethically attuned communication.