Understanding Medicine Preferences of Older Adults: The Role of Messaging in a Multi-Methods Experimental Survey

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2025-08-06 DOI:10.1111/hex.70366

Alexander Chaitoff, Kristie Rebecca Weir, Vincent D. Marshall, Sarah E. Vordenberg

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Abstract

Background

Efforts to optimise medicine use often focus on starting evidence-based therapies or deprescribing inappropriate medicine, but not on the combination of both. We explored whether behavioural science-informed messaging could impact older adults' decisions on starting and stopping diabetes medicine.

Methods

A 15-min online survey was conducted using a hypothetical vignette among adults 65 years and older from Australia and the United States. Participants were randomised in two experiments: the first involved different framings of a primary care provider (PCP)'s rationale for starting a diabetes medicine, and the second focused on stopping the same medicine 10 years later. Preferences were measured using 6-point Likert scales. Data were analysed using descriptive and nonparametric statistics. We also conducted a descriptive thematic analysis of participants' free-text responses explaining their preferences.

Results

Out of 2420 participants, 68.5% agreed with starting the medicine, whereas 64.4% agreed with stopping it (p = 0.009). The proportion of participants who agreed with the recommendation to start or stop the medicine did not differ by the messaging they received in the first experimental treatment. However, participants were more likely to agree with a recommendation to stop a medicine if they received messaging about the medicine's harms versus lack of benefit (69.7% vs. 59.1%, p < 0.001). Thematic analysis revealed that participants' trust in clinician expertise, their perceptions of the medicine (e.g., benefits, harms, necessity and burdens) and a hesitance to change influenced their decisions.

Conclusion

Two-thirds of participants agreed with the recommendation to start and stop a diabetes medicine regardless of messaging at medicine initiation. Subsequent messaging focused on the potential harm of continuing a medicine significantly increased participants' agreement with deprescribing compared to messaging about the lack of benefit.

Patient or Public Contribution

Older adult community members and general practitioners contributed to the development of the survey and vignette, helping to refine the content and improve its clarity and relevance.

Abstract Image

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了解老年人的药物偏好：信息传递在一项多方法实验调查中的作用

优化药物使用的努力往往侧重于开始循证治疗或减少不适当药物的处方，而不是将两者结合起来。我们探讨了行为科学信息是否会影响老年人开始和停止糖尿病药物治疗的决定。方法对来自澳大利亚和美国的65岁及以上的成年人进行15分钟的在线调查。参与者被随机分配到两个实验中：第一个涉及初级保健提供者（PCP）开始使用糖尿病药物的理由的不同框架，第二个侧重于10年后停止使用相同的药物。偏好是用6分李克特量表测量的。数据分析采用描述性和非参数统计。我们还对参与者的自由文本回答进行了描述性主题分析，以解释他们的偏好。结果在2420名参与者中，68.5%同意开始用药，64.4%同意停止用药（p = 0.009）。同意开始或停止用药建议的参与者的比例并没有因他们在第一次实验性治疗中收到的信息而有所不同。然而，如果参与者收到有关药物危害的信息而不是缺乏益处的信息，他们更有可能同意停药的建议（69.7%对59.1%,p < 0.001）。专题分析显示，参与者对临床医生专业知识的信任、对药物的认知（如益处、危害、必要性和负担）以及对改变的犹豫影响了他们的决定。结论：三分之二的参与者同意开始和停止糖尿病药物的建议，无论药物开始时的信息如何。与缺乏益处的信息相比，随后关注持续用药潜在危害的信息显著增加了参与者对处方的认同。老年社区成员和全科医生为调查和小插图的发展做出了贡献，帮助完善内容，提高其清晰度和相关性。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.