Why do older adults decline participation in research? Results from two deprescribing clinical trials

Trials

Commentary

Avantika S. Shah¹  Thomas E. Strayer²  Emily K. Hollingsworth²  Sandra F. Simmons³  Amanda S. Mixon⁴  Eduard E. Vasilevskis⁴ 

[1] Center for Quality Aging, Vanderbilt University Medical Center, 2147 Belcourt Ave., 37212, Nashville, TN, USA;Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Center for Quality Aging, Vanderbilt University Medical Center, 2147 Belcourt Ave., 37212, Nashville, TN, USA;Division of Geriatrics, Vanderbilt University Medical Center, 2147 Belcourt Ave., 37212, Nashville, TN, USA;Center for Quality Aging, Vanderbilt University Medical Center, 2147 Belcourt Ave., 37212, Nashville, TN, USA;Division of Geriatrics, Vanderbilt University Medical Center, 2147 Belcourt Ave., 37212, Nashville, TN, USA;Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, 1310 24Th Ave. S, 37212, Nashville, TN, USA;Center for Quality Aging, Vanderbilt University Medical Center, 2147 Belcourt Ave., 37212, Nashville, TN, USA;Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, 1310 24Th Ave. S, 37212, Nashville, TN, USA;Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, 37203, Nashville, TN, USA;

关键词: Polypharmacy;    Deprescribing;    Patient engagement;   

DOI  :  10.1186/s13063-023-07506-7

 received in 2023-04-13, accepted in 2023-07-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHeterogenous older adult populations are underrepresented in clinical trials, and their participation is necessary for interventions that directly target them. The purpose of this study was to evaluate reasons why hospitalized older adults declined participation in two deprescribing clinical trials.MethodsWe report enrollment data from two deprescribing trials, Shed-MEDS (non-Veterans) and VA DROP (Veterans). For both trials, inclusion criteria required participants to be hospitalized, age 50 or older, English-speaking, and taking five or more home medications. Eligible patients were approached for enrollment while hospitalized. When an eligible patient or surrogate declined participation, the reason(s) were recorded and subsequently analyzed inductively to develop themes, and a chi-square test was used for comparison (of themes between Veterans and non-Veterans).ResultsAcross both trials, 1226 patients (545 non-Veterans and 681 Veterans) declined enrollment and provided reasons, which were condensed into three themes: (1) feeling overwhelmed by their current health status, (2) lack of interest or mistrust of research, and (3) hesitancy to participate in a deprescribing study. A greater proportion of Veterans expressed a lack of interest or mistrust in research (42% vs 26%, chi-square value = 36.72, p < .001), whereas a greater proportion of non-Veterans expressed feeling overwhelmed by their current health status (54% vs 35%, chi-square value = 42.8 p < 0.001). Across both trials, similar proportion of patients expressed hesitancy to participate in a deprescribing study, with no significant difference between Veterans and non-Veterans (23% and 21%).ConclusionsUnderstanding the reasons older adults decline participation can inform future strategies to engage this multimorbid population.

【 授权许可】

CC BY   
© The Author(s) 2023