title: Patient perceptions of proactive medication discontinuation.
abstract: OBJECTIVE
  While many patients prefer fewer medications, decisions about medication discontinuation involve collaboration between patients and providers. We sought to identify patient perspectives on intentional medication discontinuation in order to optimize medication use.
  
  
  METHODS
  We conducted 20 interviews and two focus groups with a convenience sample of patients (22 men, 5 women; mean age 66 years) at two US Veterans Affairs Medical Centers. We queried patients' experiences with and attitudes toward taking multiple medications, preferences about taking fewer medications, and communication with their providers about stopping a medicine. Transcripts were analyzed qualitatively.
  
  
  RESULTS
  Three main themes emerged to create a conceptual model of medication discontinuation from the patient perspective: (1) conflicting views of medication, encompassing the sub-themes of desire for fewer medications, adherence, and specific versus general; (2) importance of patient-provider relationships, encompassing the sub-themes of trust, relying on expertise, shared decision making, and balancing multiple providers; and (3) limited experience with medication discontinuation.
  
  
  CONCLUSIONS
  Many patients who have a preference to take fewer medicines do not share their beliefs with providers and recall few instances of provider-initiated medication discontinuation.
  
  
  CONCLUSIONS
  Strengthening patient-provider relationships and eliciting patient attitudes about taking fewer medications may enable appropriate discontinuation of unnecessary medications.
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and ENRM Veterans Affairs Medical Center, Boston and Bedford , MA, USA; Section of General Internal Medicine, Boston Medical Center, Boston, USA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA. Electronic address: Amy.Linsky@va.gov.
authors.forename: Amy
authors.initials: A
authors.lastname: Linsky
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and ENRM Veterans Affairs Medical Center, Boston and Bedford , MA, USA; Section of General Internal Medicine, Boston Medical Center, Boston, USA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA. Electronic address: Steven.Simon2@va.gov.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and ENRM Veterans Affairs Medical Center, Boston and Bedford , MA, USA; Department of Health Policy & Management, Boston University School of Public Health, Boston, USA. Electronic address: Barbara.Bokhour@va.gov.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bokhour
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003657:Decision Making; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010358:Patient Participation; D010465:Perception; D010817:Physician-Patient Relations; D036301:Qualitative Research; D016312:Treatment Refusal; D035502:Trust
keywords: Communication; Medication safety; Patient beliefs; Shared decision making