Translation and cultural adaptation of MedStopperr®—A web-based decision aid for deprescribing in older adults: A protocol

Abstract

Background Older patients are more likely to have medication-related problems, which are associated with changes in pharmacokinetics and pharmacodynamics, multimorbidity, and polypharmacy. Polypharmacy and inappropriate prescribing are well-known risk factors which commonly cause adverse clinical outcomes in older people. Prescribers struggle to identify potentially inappropriate medications and to choose an adequate tapering approach. Methods/design The goal of the study is to translate and culturally adapt MedStopper®, an original English language web-based decision aid system in deprescribing medication, to the Portuguese population. A translation-back translation method, with validation of the obtained Portuguese version of MedStopper® will be used, followed by a comprehension test. Discussion This is the first research in the Portuguese primary care setting that aims to provide a useful online tool for the appropriate prescription of older patients. The translated version in Portuguese version of the MedStopper® tool will represent an advance that seeks to continue improving the management of medications in the elderly. The adaptation into Portuguese of the educational tool provides clinicians with a screening tool to detect potentially inappropriate prescribing in patients older than 65 that reliable and easier to use. Trial registration Retrospectively registered. Background Older adults are more likely to have medication-related problems, which are associated with changes in pharmacokinetics and pharmacodynamics, multimorbidity [1], and polypharmacy [2]. Polypharmacy can be defined as taking more than five medications simultaneously [3]. The prevalence of this phenomenon can range from 30 to 70% [4], but in Portugal, it is estimated to reach up to 77% of the elderly population [5]. Deprescribing is the process of stopping or tapering an inappropriate medication [6]. It is not just a way of managing polypharmacy; it has the clear goal of improving patient outcomes. Despite the importance of adequate deprescribing, there are several barriers to its success, such as patient reluctance, limited time, medical, cultural inertia, and difficulty in recognizing potentially inappropriate medications [PIMs] [7]. PIMs can be described as the use of medications that potentially have more risks than benefits even though safer pharmacologic and nonpharmacologic alternatives are available [8]. These PIM are listed in several clinical tools, for example, by the EU PIM-List [9], Beers Criteria [10], and the Screening Tool of Older People’s Prescriptions (STOPP) and the Screening Tool to Alert to Right TreatmentSTART) [11]. Nevertheless, it is hard to recognize inappropriate medications in individual patients [7], and computerized decision support tools may help to address polypharmacy [12], reduce the number of potentially inappropriate prescriptions started and the mean number of potentially inappropriate prescriptions per patient [13]. For all of this, having a computerized decision support tool that includes both Beers criteria and STOPP/START could enhance deprescribing. The MedStopper1 is an excellent example of such tool being a web tool that integrates both Beers criteria and STOPP/START. It was developed to help clinicians and patients to make decisions about reducing or stopping medications. By entering the list of medications, a patient is receiving, MedStopper1 sequences the drugs from “more likely to stop” to “less likely to stop”, based on three key criteria: the potential of the drug to improve symptoms, its potential to reduce the risk of future illness, and its likelihood of causing harm. Three rating levels under each of the ranking categories: Unhappy Face, Neutral Face, and Happy Face. Suggestions for how to taper the medication are also provided and possible symptoms when stopping or tapering. The MedStopper1 is available in two languages: English and French [14]. At first, the user is asked to identify if the patient is a frail elderly; after that, the user can search for medications by generic or brand name; in the next step, the user is asked to select the condition for which the medication is used. The MedStopper1 Plan will display the medications in order of stopping priority and in colors: red is the highest stopping priority and green the lowest stopping priority. We aim to translate and culturally adapt MedStopper1, an original English language web-based decision aid system in deprescribing medication, to the Portuguese population [14].