Communication Preferences of Caregivers and Prescribers for Deprescribing Bisphosphonates in Older Adults Living With Dementia

Bisphosphonates are potential targets for deprescribing in older adults with dementia as goals of care change from preventive to palliative. Yet, prescribers lack communication guidance to address deprescribing. We sought to characterize and compare communication preferences of prescribers (n=12) and family/informal caregivers (n=11) regarding bisphosphonate deprescribing through semi-structured interviews. Prescribers and caregivers were asked to provide their impressions of seven conversation starters for discussing deprescribing bisphosphonates. For prescribers, the most frequently preferred conversation starter for deprescribing focused solely on increased risk of adverse effects, while caregivers most frequently preferred deprescribing conversations focused on weighing both risks and benefits. The least preferred conversation starter for deprescribing among both groups focused on the extra effort and cost of continuing bisphosphonates. While caregivers and prescribers align on some communication preferences, this study identifies nuanced differences in preferred communication about deprescribing bisphosphonates. The results of this study could be used to develop more effective clinical guidance for prescribers and education materials for caregivers to facilitate effective conversations about deprescribing bisphosphonates.