A Conversation Aid for Climate Conscious Inhaler Prescribing

Climate-conscious inhaler prescribing involves preferential selection of low-carbon-footprint devices while considering patient safety and preferences.

What should be the content and design of inhaler conversation aids to facilitate climate-conscious prescribing for asthma and COPD?

We developed a prototype for a web-based conversation aid, with tailored versions by medication class, age group, and disease (asthma or COPD). These provide information on inhaler contents, dosing, carbon footprint, cost, and safety considerations. We undertook an iterative rapid-cycle development process involving semistructured interviews with family physicians; focus groups with patients with asthma, COPD, or both; and an online survey to optimize content and usability. After each round (interview and focus group), we identified emerging themes and critical changes and revised the tool accordingly. This process was repeated, with new participants, until predefined stopping criteria were met.

Over 5 rounds, we recruited 25 patients (44% female) with asthma (n = 10), COPD (n = 9), and asthma and COPD overlap (n = 6) and 5 family physicians. Serial changes included: simplifying language; clarifying cost, drug coverage, and dosing information; increasing the prominence of hover and safety messaging; and revising messaging to address inadvertent guilt or nonadherence among patients unable to switch to lower-carbon-footprint devices. Patients and physicians rated the tool highly on content, format, usability, and impact and endorsed that it would increase confidence in low-carbon-footprint inhaler selection.

Our results show that engaging end users throughout development provided insights into user priorities and supported the cocreation of conversation aids that aim to facilitate shared decision-making at the point of care.