Discussion
RECRUITMENT
This descriptive study explored the reasons hospitalized older adults declined participation in two deprescribing trials. We identified three main themes: feeling overwhelmed by their current health status, a lack of interest or mistrust in research, and hesitation toward the deprescribing intervention. Older hospitalized patients’ reports of “feeling overwhelmed by their current health status” is consistent with prior studies demonstrating that health status impacts the ability or desire of older adults to participate in clinical research [The reported “lack of interest or mistrust in research” suggests a need to improve older adults’ understanding of clinical trial research and the potential benefits of participation. This effort also should address common myths or biases about research participation (e.g., not wanting to be a “guinea pig”). In this study, a greater proportion of Veterans expressed this concern relative to non-Veterans as a reason for declining enrollment, although it remained common in both groups. One potential way to address this barrier might be to consider the training and professional credentials of the study personnel responsible for enrollment [Lastly, a significant proportion of both groups declined participation due to hesitancy toward the deprescribing intervention. This category included patients reporting comfort with their current medications, despite meeting clinical criteria for polypharmacy, and/or the desire for medication changes to be made only by their prescribing providers, or a prior negative experience with a medication change. Overall, concerns about medication changes represented approximately 20% of the reasons for declining enrollment, which suggests a potential enrollment bias toward patients more willing to deprescribe in both clinical trials, which is important to acknowledge when examining intervention effects. Hesitancy toward enrolling in a deprescribing intervention might also indicate a lack of awareness or understanding of the risk of polypharmacy or patient-centered deprescribing interventions. This finding suggests that it may be informative for researchers to document reasons for declining enrollment during recruitment for clinical intervention trials as the potential for enrollment bias (i.e., those more aware of and/or willing to comply with an intervention) is relevant to the evaluation of many types of behavioral health interventions.Representativeness in the population might be better achieved through tailoring study procedures based on the intervention, setting, and target sub-population. Additionally, studies should include multiple recruitment strategies with resources and personnel acceptable to the target population. Currently, the US Deprescribing Research Network formally engages patient and community stakeholders to increase overall awareness on the topic and elicit feedback on deprescribing study designs (US Deprescribing Network, n.d.).