Stakeholder Perceptions for the Development of Gabapentinoid Deprescribing Clinical Guideline: A Functional Role Theory Approach

Abstract Background Gabapentinoids are increasingly prescribed for a range of indications, despite growing concerns about their long-term safety and limited evidence of effectiveness for off-label use. While deprescribing is a recognised strategy to mitigate medication-related harm, clear tapering guidance for gabapentinoids is lacking. Objective To explore consumer and healthcare professional (HCP) perceptions of the need and scope of a gabapentinoid deprescribing clinical guideline. Design An exploratory qualitative study was conducted using semi-structured interviews. Participants A total of 25 participants were interviewed, comprising 13 consumers and 12 HCPs (e.g. general practitioners, pharmacists, neurologists). Approach Reflexive thematic analysis was applied, guided by functional role theory, to examine stakeholders’ perceptions of their own and others’ roles in gabapentinoid deprescribing and expectations, to inform subsequent guideline development. Key Results Gabapentinoid deprescribing was viewed by stakeholders as a holistic, system-wide activity involving not only prescribers but also allied health professionals. All stakeholders identified a need for guideline recommendations that reflect this complexity and inclusivity. Consumers experienced fragmented care, partly because both they and GPs were left to navigate the deprescribing process without formal guidance. HCPs identified divided responsibilities between prescribers initiating and those tasked with deprescribing, leading to subsequent challenges, particularly for GPs in managing long-term effects. HCPs valued promoting a ‘prescribing continuum’ over adopting dichotomous roles that separate prescribing from deprescribing. Consumers, including carers, expressed a desire to be central in both the development of guidelines and the process of deprescribing. Stakeholders articulated the need for a deprescribing guideline that addresses the realities of gabapentinoid use in practice. Conclusion Gabapentinoid deprescribing guidelines should be co-designed with consumers and inclusive of diverse HCPs, addressing role ambiguity and supporting continuity of care. Consumers expressed desire to be actively involved in guideline development and HCPs recognised the need for coordinated care and shared accountability across the healthcare system.