Deprescribing Tool for Older PeoPle with Limited‐life Expectancy (De‐TOPPLE) version 1: Development and validation using a modified Delphi technique

Abstract

AbstractDeprescribing decision making in older adults with limited life expectancy is often challenging for clinicians. We aimed to develop and validate a Deprescribing Tool for Older People with Limited‐life Expectancy (De‐TOPPLE). Modified Delphi technique was used to gain experts' consensus on the tool and further develop using their feedback. Experts [Round‐1 (n = 13), Round‐2 (n = 7)] had clinical and/or research background on geriatric medicine, geriatrics, family medicine or pharmacotherapy. Round‐1 consensus was achieved on approach taken by the tool to evaluate risk and benefit; distinguishing medications as preventive, symptom control or dual–purpose; referring to established deprescribing process; stepwise approach to deprescribing; and the overall concept. Common feedback was to reflect upon harm‐benefit analysis, distinguish medication types earlier, qualify adverse events, use time‐to‐benefit (TTB), prioritise symptom relief, monitor post‐deprescribing, include shared decision making and define terms for clinical familiarisation. After tool update, Round‐2 consensus was achieved on usability in clinical setting, flexibility of implicit judgement, ceasing preventive medication with inadequate TTB, ceasing symptom control medication with inadequate symptom relief, ceasing dual‐purpose medication (DPM) with inadequate TTB and symptom relief, and continuing DPM with adequate TTB and symptom relief. De‐TOPPLE version 1 was developed and validated through two rounds of the Delphi process. Clinical use of the tool needs final validation following the addition of contextual statements to the tool.