Development and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire: versions for older adults and caregivers

Abstract

Background: Knowledge of consumer (patient and caregiver) attitudes is essential for conducting medication optimization in practice. Objectives: The aim of this study was to develop and validate a questionnaire to capture older adults' and caregivers' beliefs and attitudes towards deprescribing. Methods: The previously validated Patients' Attitudes Towards Deprescribing (PATD) questionnaire was expanded based on literature review, expert opinion and focus groups, and a caregivers' version was developed. The revised questionnaire was piloted and then distributed for self-completion to older adults (≥65 years of age), taking at least one regular medication and caregivers of older adults. Psychometric validity and reliability were examined. Responses to questions that were identified to group into a specific factor were combined to produce a score. Results: A total of 383 consumer questionnaires and 200 caregiver questionnaires were completed and included in analysis. Exploratory factor analysis revealed four factors in both versions of the questionnaire (with four to five questions retained in each factor). The factors relate to the perceived burden of medication taking, belief in appropriateness of medication use (harms and benefits), concerns about stopping the medication, and level of involvement/knowledge of medications. Internal consistency of all factors was acceptable with Cronbach's alpha >0.6. In both the older adults' and caregivers' versions, the burden score was inversely associated with the appropriateness score (p < 0.001 both versions). Factor scores between administration times (test-retest reliability) were statistically significantly correlated (p = 0.000), with gamma values ranging between 0.57 and 0.89. Conclusion: The revised PATD questionnaire had acceptable validity and reliability. This newly validated questionnaire may provide insight into individuals' willingness for/barriers to deprescribing, with applications in practice and research.