Barriers and enablers to integrating deprescribing recommendations into clinical practice guidelines: a qualitative...

To examine the barriers and enablers to integrating evidence-based deprescribing recommendations into clinical practice guidelines.

Qualitative semi-structured interviews were conducted with guideline developers (including chairs, methodologists, clinicians, and consumers) and key interest-holders from organizations supporting guideline development. Participants were recruited internationally, through purposive sampling via professional organizations, conference promotion, personal networks, social media, snowball sampling, and direct contact with individuals identified from publicly available guideline records. The interviews were audiotaped, transcribed, and analyzed using inductive conventional content analysis.

A total of 25 participants were interviewed, comprising 18 guideline developers (n = 11 involved in treatment guidelines; n = 7 involved in deprescribing-focused guidelines) and seven key interest-holders. Participants had experience developing guidelines across regions including Australasia, North America, and Europe, with involvement ranging from a single guideline to more than 10. The analysis revealed 10 themes and 34 subthemes, encompassing barriers, enablers, or both. The themes included (1) attitudes and knowledge of deprescribing; (2) alignment with the goals of guidelines; (3) alignment with other care initiatives; (4) internal influence on guideline scope; (5) external influence on guideline scope; (6) logistical considerations; (7) evidence to inform recommendations; (8) deprescribing recommendation components; (9) implementation considerations; and (10) potential consequences.

The inclusion of deprescribing recommendations in clinical practice guidelines aligns with the goals of guidelines. However, challenges remain such as ensuring its inclusion within the guideline scope from the outset and overcoming logistical barriers. Further consultation and research are needed to determine how best to leverage potential enablers. This may include providing methodological support for guideline developers and exploring end-users' preferences for the content, language, and format of deprescribing recommendations to enhance guideline implementation in practice.

This study explored what helps or hinders the inclusion of deprescribing recommendations (guidance on when and how to reduce or stop medications) within clinical practice guidelines. Although deprescribing is increasingly recognized as an important part of safe and effective care, many existing guidelines provide limited direction on how to approach it. Understanding why deprescribing guidance is not routinely included, and what might support its integration, is important for improving patient care. To investigate this, we conducted in-depth interviews with people involved in developing clinical practice guidelines. Participants included guideline chairs, guideline methods experts, clinicians, consumer representatives, and individuals from organizations that support guideline development. They were recruited internationally through professional networks, conferences, social media, and publicly available guideline records. Interviews were recorded, transcribed, and analyzed to identify common themes. We interviewed 25 people from regions including Australasia, North America, and Europe. Eighteen were guideline developers, and seven were individuals with a broader interest in guidelines. Their experience ranged from contributing to a single guideline to working on more than 10. From the interviews, we identified 10 major themes and 34 subthemes describing both barriers and enablers to integrating deprescribing into guidelines. Participants agreed that deprescribing fits well with the overall goals of guidelines, such as improving patient outcomes and reducing harm. Challenges included limited awareness or understanding of deprescribing, uncertainty about the strength or type of evidence needed to support deprescribing recommendations, and practical constraints such as time, resources, and the complexity of guideline development processes. External influences, including expectations from regulators or other interested groups, also shaped what could be included. Opportunities to strengthen deprescribing guidance included clearer recommendations, better alignment with other efforts to improve care, and practical resources to support routine use. Overall, the study shows that while deprescribing fits naturally within the purpose of guidelines, practical and structural barriers can limit its inclusion. Further work is needed to support guideline developers, strengthen the evidence base, and understand what healthcare professionals and consumers need to make deprescribing recommendations more useful in everyday practice.