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

Area of Science:

• Gerontology
• Palliative Care
• Health Services Research

Background:

• Polypharmacy is prevalent in hospice settings, increasing patient burden and misaligning care goals.
• Current deprescribing practices in hospice are inconsistent and lack ethical responsiveness, especially concerning emotional readiness.

Purpose of the Study:

• To develop a theory-informed framework for deprescribing in hospice care.
• The framework integrates ethical reasoning and emotionally intelligent communication.

Main Methods:

• Semi-structured interviews were conducted with 15 hospice clinicians (physicians, nurses, pharmacists).
• Interviews were guided by the Theoretical Domains Framework Version 2 (TDFv2) and data were thematically analyzed.
• Deprescribing determinants were mapped to TDFv2 domains, prioritized, and linked to Behavior Change Techniques (BCTs).

Main Results:

• Ten key determinants of deprescribing were identified and mapped to seven TDFv2 domains.
• Key determinants included inconsistent guidance awareness, reliance on clinical judgment, patient emotions (fear, anxiety), need for ethical framing, patient-centered justifications, ethical uncertainty, and system-level gaps.
• The developed framework includes Contextualized Deprescribing (CoDe) with electronic prompts and Ethical Therapeutic Insight for Compassionate Communication (ETHIC-Talk) with communication strategies.

Conclusions:

• The CoDe/ETHIC-Talk Framework offers a structured, context-sensitive approach to hospice deprescribing.
• It aims to integrate clinical support with ethically attuned communication.
• Further feasibility evaluation is pending.