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

OBJECTIVE: To examine the barriers and enablers to integrating evidence-based deprescribing recommendations into clinical practice guidelines. STUDY DESIGN AND SETTING: 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. RESULTS: 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. CONCLUSION: 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.