Healthcare professionals’ attitudes toward deprescribing in older adults with limited life expectancy in an Ethiopian teaching hospital: a cross-sectional study

Abstract

Objective

To assess the Attitudes of Healthcare Professionals Towards Deprescribing in older adults with Limited Life Expectancy.

Design

An institution-based, cross-sectional, and quantitative survey was conducted.

Setting

Mainly the Oncology ward of the University of Gondar Medical Center in Ethiopia.

Participants

Healthcare professionals (HCPs) who worked in the oncology ward and had more than 1 year of experience at the University of Gondar Medical Center.

Main outcome measures

Healthcare professionals’ attitudes toward deprescribing in older adults with limited life expectancy were assessed using the standardized Healthcare Professionals Attitude Towards Deprescribing (HATD) tool. Data were collected using self-administered questionnaires with physicians, nurses, and pharmacists possessing at least one year of professional experience. A convenience sampling technique was employed, and all participants were briefed on the study’s objectives prior to recruitment. Statistical analysis was performed using SPSS version 26. Descriptive statistics summarized the data, while bivariate (chi-square) analyses were conducted to identify significant associations. The significance of these associations was declared at a 95% confidence interval, p < 0.05.

Results

Of the 140 HCPs approached, all 140 HCPs (100% response rate) had a mean age of 30.95 ± 3.57 years, with a range of 15 years, and were included in the final analysis. From a total of 140 participants, 86 (61.42%) were males, and 54 (38.58%) were females. From the concern factor domain, 90.70% of the participants believed that stopping medicines would lead to deterioration of the health conditions of their patients. In comparison, 71.52% of the participants felt that patients taking large numbers of medications can benefit from medication deprescribing. Sex and work experience were found to have statistically significant associations with the HCPs’ attitudes towards favorable and unfavorable deprescribing practices. A total of 86 physicians were included in the final analysis; of these, 44 (51.20%) exhibited favorable attitudes toward deprescribing. Similarly,19 out of 36 pharmacists (52.80%) and 10 out of 18 nurses (55.60%) demonstrated favorable attitudes (X² = 0.12, P = 0.94).

Conclusion

This study revealed that a slight majority of participants held favorable attitudes toward deprescribing, highlighting its potential benefits for older adults with limited life expectancy. Furthermore, work experience and sex were associated with attitude classification in this single-center study.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12875-026-03464-6.

Introduction

Polypharmacy is very common among older adults and is usually defined as the simultaneous use of five or more medications for a single patient [1]. It has been linked to higher risks of adverse drug effects and increased healthcare costs, as well as various geriatric syndromes, such as functional decline and chronic complications, unless it is properly assessed and managed. Although the prevalence of polypharmacy varies depending on the clinical setting and specific health conditions, research indicates that over 37.1% of older adults are affected, with this rate rising to 51.4% among hospitalized patients [1–3].

Polypharmacy and the use of potentially inappropriate medications (PIMs) in older adults with limited life expectancy are often linked to a lower quality of life, drug interactions, adverse drug reactions, increased hospitalizations, higher mortality rates, and other common healthcare challenges today, i.e., intensification of adverse drug events, drug-drug interactions, escalating extra health costs, and reduced patient adherence associated with polypharmacy [1, 2, 4]. Polypharmacy in aged individuals is becoming more widespread, and it is the most valuable public concern. In the upcoming years, providing care for the expanding population of older adults who have multi-morbidities and complex medication regimens will become a significant problem [3].

Deprescribing, the planned process of identifying and discontinuing medications where risks outweigh potential benefits, is a crucial clinical strategy to mitigate these harms and shift the clinical focus toward improving quality of life [4]. However, implementing this process is complex. Older adults with limited life expectancy often face physiological vulnerabilities that complicate drug metabolism and necessitate a refined approach to pharmacotherapy [3, 4]. Despite the clinical imperative, evidence supporting deprescribing in this population is sparse, and clinical trials frequently exclude patients with terminal illnesses, leading to a paucity of guidelines [3]. Deprescribing involves the careful identification, reduction, or cessation of medications when their risks outweigh the benefits, under the guidance of healthcare professionals. This process considers the patient’s therapeutic goals, functionality, and needs [4]. Key principles include reviewing current medications, selecting those to discontinue, replace, or reduce, creating a discontinuation plan with the patient, and providing ongoing monitoring and support [3, 4].

Older adults with limited life expectancy typically have a prognosis of 6 to 12 months. As health declines, the physiological risks of medications often increase, while their potential benefits diminish. Deprescribing medications for these individuals shifts the clinical focus from long-term prevention to immediate quality of life. This practice in that population reduces the number of prescribed drugs and minimizes potential risks associated with polypharmacy [5]. Although HCPs play a pivotal role in deprescribing processes for older patients with limited life expectancy, their attitudes towards this practice have not been assessed or improved in resource limited set ups. Therefore, it is important to identify the barriers that could help enhance HCPs’ attitudes towards deprescribing in older adults with limited life expectancy [5–7].

Deprescribing inappropriate polypharmacy offers several benefits to patients, including reducing medication costs and adverse drug events, decreasing pill burdens, helping them to be more adherent to their medications, and enhancing overall quality of life. This is especially relevant in developing countries like Ethiopia, where patients primarily cover drug expenses out-of-pocket, and a significant portion of medications are purchased from private retail outlets [6, 7]. Deprescribing can help optimize medication use and improve functioning in older adults by reducing potentially harmful polypharmacy. The goal of deprescribing is to improve health outcomes by discontinuing medications that are no longer necessary or appropriate due to changes in clinical conditions or patient priorities [4–6, 8].

Deprescribing in older patients with limited life expectancy under palliative care is complex for several reasons [9]. Firstly, the amplified complexity of physiological changes in this population, such as body mass, metabolism, and elimination, along with the possibility of weakness, can potentially alter the pharmacokinetics and pharmacodynamics of any medication being used [10, 11]. Secondly, there is a paucity of evidence on deprescribing guidelines in this group of patients [12, 13]. Thirdly, it has been reported that clinical studies tend to exclude around 80% of individuals due to medical co-morbidities that include life-threatening illnesses [14, 15]. Lastly, a review on deprescribing trials states that limited studies are exploring the clinical outcomes of deprescribing in those < 65 years, and the results are inconsistent [16, 17]. It also provides baseline data to further investigate healthcare professionals’ and Patient’s knowledge regarding prescribed medication. Moreover, the findings may call for the attention of concerned bodies to make decisions and take measures in the spirit of improving the patients’ knowledge, suggesting that rational ideas on the proper usage of medicines yield better results in patient health status [16].

The gap of deprescribing is especially acute in resource-limited settings like Ethiopia, which needs emphasis to be addressed. In these environments, patients often bear the burden of out-of-pocket medication expenses, and the integration of geriatric-focused palliative care into standard oncology services remains suboptimal [17]. Healthcare professionals in Ethiopian teaching hospitals navigate a complex landscape characterized by high patient volumes, limited multidisciplinary collaboration, and a lack of standardized, locally relevant deprescribing protocols [15]. As clinicians serve as the primary gatekeepers of medication safety, understanding their attitudes toward deprescribing is essential to identify the systemic barriers to integrating these practices into routine oncological care. Therefore, this study aimed to assess healthcare professionals’ attitudes toward deprescribing in older adults with limited life expectancy at UoGCSH and to explore associated sociodemographic factors in Northwest Ethiopia.

Materials and methods

Study design, setting, and period

A hospital-based cross-sectional study design was conducted from July 27 to August 15, 2022, to evaluate HCPs’ attitudes toward deprescribing in older adults with limited life expectancy at the UoGCSH in Ethiopia. This design was chosen as it allows for the simultaneous assessment of exposure (professional role and experience) and outcome (attitudes) within a defined population at a single point in time. The UoGCSH is located in Gondar, northwestern Ethiopia, 738 km from the capital city, Addis Ababa, and 180 km from Bahir Dar, the capital of the Amhara Regional State. The hospital comprises eight wards: Surgery, Pediatrics, Internal Medicine, Emergency, Psychiatry, Chemotherapy, MDR, Gynecology, and Ambulatory. The study was primarily conducted in the oncology (chemotherapy) ward.

Study participants

Healthcare professionals, including physicians, nurses, and pharmacists, with at least one year of clinical experience in the oncology ward at the University of Gondar Medical Center, were recruited for this study. These disciplines were selected because physicians serve as the primary decision-makers for deprescribing, pharmacists act as key advisors on drug safety and interactions, and nurses serve as frontline observers of medication side effects and patient quality of life. A total of 140 HCPs who met the inclusion criteria were recruited using convenience sampling. As all participants held university degrees in medicine, nursing, or pharmacy, they possessed the necessary English proficiency for all study communications.

All eligible HCPs working in the oncology ward during the study period were approached personally by the research team. To facilitate participation, the team administered surveys during working hours, provided brief orientation sessions on the study’s importance, and maintained open lines of communication. No eligible HCPs declined to participate or were unavailable during the study period.

Inclusion criteria

The study included healthcare professionals, specifically physicians, pharmacists, and nurses who were permanent employees at UoGCSH with at least one year of clinical work experience.

Study variables and operational definitions

This study assessed HCPs’ attitudes toward deprescribing in older adults with limited life expectancy. The primary outcome variable was attitude, operationally defined as the degree of favorability or unfavourability expressed by participants regarding the planned process of reducing or stopping medications (deprescribing) when the harms outweigh the benefits [17, 18]. The independent variables included socio-demographic factors such as age, gender, type of health profession, and years of clinical work experience. For this study, polypharmacy was defined as the concurrent use of five or more medications [19]. A life-limiting illness was defined as a condition that cannot be cured and which is likely to result in death [20], while limited life expectancy referred to a clinical prognosis where a terminal disease has been diagnosed, and life duration can be estimated based on current treatment availability [21]. An adverse drug event (ADE) was defined as any patient harm resulting from exposure to a medication, encompassing drug reactions, medication errors, overdoses, and allergic responses [9, 21]. Finally, older patients were defined as individuals aged 65 years or older [18].

Data collection procedures and tools

Ethical approval and informed consent were obtained from the Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Gondar, and the study participants. The data were collected by two of the authors using a structured questionnaire, which was developed using the HATD standard tool after permission to use the tool [22]. The questionnaire was then checked for face and content validation by experts and run using the KoBo Toolbox, interviewed in a closed package.

After developing and validating the questionnaire, data were collected from 140 healthcare professionals (Physicians, Nurses, and Pharmacists) who provided their consent to participate in the study. Healthcare professionals’ attitudes towards deprescribing were measured using the HATD standard tool. The questionnaire was developed after permission for the use of the HATD standard tool [22]. The questionnaire consisted of 27 items in total, which were divided into two distinct sections: the sociodemographic information Sect. (4 items) and the HATD tool (23 items). The HATD tool itself is categorized into five factors: Concerns factor (7 items), Burden factor (7 items), Organizational factor (4 items), Assurance factor (2 items), and Patient-involvement factor (3 items). A 5-point Likert scale (strongly disagree = 1, disagree = 2, neutral = 3, agree = 4, strongly agree = 5) was utilized for each statement to record professional responses. Higher scores (strongly agree = 5) represented a greater extent to which they have a favorable attitude towards deprescribing, while lower scores (strongly disagree = 1) represented a lesser extent to which HCPs have unfavorable attitudes.

Data quality control (assurance)

Internal consistency

The tool underwent a validation process to ensure its suitability for the study context, including content validity assessment by three experts and a pilot study. Following their feedback, minor linguistic adjustments were made. A pilot study was then conducted with 10% (14 healthcare professionals) (not included in the final sample) to evaluate face validity and the time needed for completion. Finally, the internal consistency of the tool was assessed using Cronbach’s alpha, which resulted in a coefficient (α) of 0.79. This Cronbach’s alpha (α = 0.79) pertains to the full HATD scale. We used the total scale score as our primary measure to provide a comprehensive overview of HCPs’ attitudes toward deprescribing.

Patient and public involvement statement

Research gaps were identified during routine follow-up, medication reviews, and counseling for older adults with limited life expectancy, primarily in the oncology ward at UoGCSH. During these follow-ups, we found that older adults with limited life expectancy were exposed to polypharmacy and inappropriate drug combinations, leading to diminished medication adherence. Various instruments exist to measure adherence and PIM use. While the former is commonly assessed through patient self-reports, the latter is determined using explicit (list-based) or implicit (judgment-based) methods¹. In our routine follow-up before the study, we evaluated medication adherence using self-report mechanisms, specifically by developing checklists to monitor participants’ medication-taking behavior.

Healthcare providers contributed to the design of the current study by helping to identify research questions and highlighting the need to explore deprescribing concepts. The participants (HCPs) were also involved by encouraging the authors to conduct the research to assess HCPs’ attitudes, emphasizing the burden of polypharmacy and the need to explore deprescribing concepts.

The study’s findings will be shared with participants, other healthcare providers, and patients in easy-to-understand formats during healthcare services and educational programs. The authors will also present the findings at national and international conferences.

Data processing and analysis

Data were analyzed using SPSS Version 26. Descriptive statistics, including frequencies and percentages, were used to summarize the sociodemographic characteristics of the participants and the distribution of their responses. To examine the associations between categorical independent variables (such as profession, years of experience, and gender) and the primary outcome (attitude), bivariate analysis (Chi-square) tests were employed. All results are reported with 95% Confidence Intervals (CIs) to indicate the precision of the estimates. Statistical significance was defined as a p-value < 0.05.

Results

Socio-demographic characteristics of the participant

Of the 140 HCPs approached, all 140 (100% response rate) were included in the final analysis. The participants had a mean age of 30.95 ± 3.57 years (median: 30; range: 25–40 years). Most of the healthcare professionals were aged 25–30 (56.4%), male (61.4%), and physicians (61.4%), with 50.7% reporting more than 3 years of work experience (Table 1).

Table 1.

Socio-demographic characteristics of the healthcare professionals by the mean score (n = 140)

Variable	Category	Frequency (N)	Percentage (%)
Sex	Male	86	61.4
	Female	54	38.6
Age in years	25–30	79	56.4
	31–35	43	30.7
	> 36	18	12.8
Types of profession	Physician	86	61.4
	Nurse	18	12.9
	Pharmacist	36	25.7
Work experience in Years	1–3	69	49.3
	4 and above	71	50.7

The attitude of health professionals toward deprescribing

As summarized in Table 2, a total of 140 participants responded to 23 HATD questions. In the concern factor domain, a total of 127 professionals (90.7%) thought that stopping medicines would lead to deterioration of the health of her/ his patients, whereas in the burden factor, a total of 100 professionals (71.5%) felt that patients are taking a large number of medicines. The organizational factor domain showed that close to 85% of professionals believe that they could deprescribe some of their medicines if they had time with the patient. From the assurance factor, 85.7% of professionals feel that they need extra training on medication-related problems to deprescribe or recommend deprescribing. The patient involvement factor domain showed that 78.6% of professionals think that most of their patients did not know exactly what medicines they were taking.

Table 2.

Healthcare professionals’ attitudes towards deprescribing based on HATD questionnaires (n = 140)

Questions	Strongly Disagree N (%)	Disagree N (%)	Neutral N (%)	Agree N (%)	Strongly Agree N (%)
Concern factor	1(0.7)	4(2.9)	8(5.7)	100(71.4)	27(19.3)
I am concerned that stopping medicines would cause the health of my patients to deteriorate
I often feel reluctant to stop or recommend stopping medicines due to uncertainty around prognosis and life Expectancy	8(5.7)	16(11.4)	27(19.3)	76(54.3)	13(9.3)
I am concerned that stopping one or more medicines might cause symptoms to return in some patients	1(0.7)	9(6.4)	12(8.6)	90(64.3)	28(20)
I am reluctant to deprescribe or recommend deprescribing due to the pressure to treat according to death-specific treatment Guidelines	4(2.9)	32(22.9)	30(21.4)	61(43.6)	13(9.3)
I feel reluctant to stop or recommend stopping medicines initiated by Specialists	22(15.7)	46(32.9)	12(8.6)	37(26.4)	23(16.4)
I am concerned that my patients, their relatives, and other healthcare professionals may interpret coincidental deterioration as a direct outcome of Deprescribing	6(4.3)	37(26.4)	26(18.6)	51(36.4)	20(14.3)
I have come across some patients who have had a bad experience after stopping their medicines	4(2.9)	25(17.9)	22(15.7)	63(45)	26(18.6)
Burden factor	1(0.7)	21(15)	18(12.9)	75(53.6)	25(17.9)
I am concerned that many of my patients are taking a large number of Medicines
Sometimes I think some of my patients may be taking one or more medicines that they no longer need	2(1.4)	19(13.6)	22(15.7)	68(48.6)	29(20.7)
I think stopping one or more medicines could improve the quality of life of most of my Patients	12(8.6)	61(43.6)	30(21.4)	32(22.9)	5(3.6)
I feel that medicines are a burden to most of my patients	8(5.7)	37(26.4)	8(5.7)	68(48.6)	19(13.6)
Sometimes I think my patients are on too many medicines	2(1.4)	23(16.4)	17(12.1)	81(57.9)	17(12.1)
I think reducing the dose of one or more medicines could improve the quality of life of most of my Patients	4(2.9)	48(34.3)	50(35.7)	36(25.7)	2(1.4)
I am concerned about the burden that managing medicines has on most of my patients	2(1.4)	42(30)	32(22.9)	56(40)	8(5.7)
Organizational factor	3(2.1)	27(19.3)	12(8.6)	79(56.4)	19(13.6)
I feel my current workload hinders deprescribing
I feel inadequate staffing at my workplace hinders deprescribing	4(2.9)	20(14.3)	12(8.6)	84(60)	20(14.3)
I feel appropriate reimbursement would encourage deprescribing Practice	1(0.7)	14(10)	22(15.7)	89(63.6)	14(10)
I believe that if I had more time with patients, I/we could deprescribe some of their medicines	1(0.7)	11(7.9)	9(6.4)	88(62.9)	31(22.1)
Assurance factors	2(1.4)	5(3.6)	13(9.3)	76(54.3)	44(31.4)
I feel extra training is needed on medication-related problems to deprescribing
I think that there is a lack of evidence to support Deprescribing	4(2.9)	23(16.4)	34(24.3)	54(38.6)	25(17.9)
Patient Involvement Factor	28(20)	82(58.6)	8(5.7)	20(14.3)	2(1.4)
I think most of my patients know exactly what medicines they are on Taking
I think most of my patients have a good understanding of the reasons that their medicines were prescribed	23(16.4)	77(55)	14(10)	24(17.1)	2(1.4)
I think most of my patients are proactive in asking another healthcare professional if there is something they do not understand about their medicines	26(18.6)	50(35.7)	20(14.3)	41(29.3)	3(2.1)

Adopted from the Healthcare Professionals’ Attitudes towards Deprescribing (HATD) questionnaire ¹⁷.

The attitude of health professionals towards deprescribing was classified into two major categories (I) favorable attitudes, which consist of agree, strongly agree, and favorable, and (II) unfavorable attitudes which consist of neutral, disagree, and strongly disagree.

In the current study, about (52.10%, 95% CI: 43.6, 60.70) of health professionals had favorable attitudes. Whereas, (47.90%, 95% CI; 39.3, 56.70) healthcare professionals had unfavorable attitudes towards deprescribing (Fig. 1).

Fig. 1.

Attitude of healthcare professionals towards deprescribing

Relationship between attitude and socio-demographic characteristics

The chi-square test was conducted as a comparison of professional categories with favorable and unfavorable attitudes toward deprescribing (Table 3). Gender and work experience of the participants had an association with healthcare professionals’ attitudes with X² =15.038, P < 0.001, and X² = 33.013, P < 0.001, respectively. On the other hand, between the age of professionals and the type of profession had no association with professionals’ attitudes, with X² = 1.971, P = 0.578, and X² = 0.123, P = 0.940, respectively. The unfavorable attitudes of male and female professionals were 34.9% and 65.5%, respectively. On the other hand, 76.1% of Professionals that have 4 and above years of work experience had a favorable attitude towards deprescribing.

Table 3.

Relationship between attitude and socio-demographic characteristics of healthcare professionals (n = 140)

Variables	Category	Total	Attitude		Statistical test (X2)
			Favorable Attitude N (%)	Unfavorable Attitude N (%)
Sex	Male	86	56(65.1)	30(34.9)	X2 = 15.038 P < 0.001
	Female	54	17(31.5)	37(68.5)
Age	25–30	79	41(51.9)	38(48.1)	X2 = 1.971 P = 0.578
	31–35	43	24(55.8)	19(44.2)
	> 36	18	8(44.4)	10(55.6)
Type of profession	Physician	86	44(51.2)	42(48.8)	X2 = 0.123 P = 0.940
	Nurse	18	10(55.6)	8(44.4)
	Pharmacist	36	19(52.8)	17(47.2)
Work experience in the year	1–3	69	19(27.5)	50(72.5)	X2=33.013 P < 0.001
	4 and above	71	54(76.1)	17(23.9)

Table 3 also showed that, in the chi-square test of association, work experience and the sex of HCPs were found to be statistically associated with their attitudes towards deprescribing (X² = 33.013, P < 0.001).

Discussion

During our routine follow-up in the oncology ward at UoGCSH, we encountered older adults with limited life expectancy who were exposed to polypharmacy and experiencing adverse drug effects due to inappropriate drug combinations [23]. We then collaborated with the HCPs working in the ward to discuss the effects of polypharmacy and developed a plan to reduce the patients’ medication through deprescribing. A convenience sampling method was identified as the most suitable approach for participant recruitment. Although this non-probability method may introduce selection bias, we sought to minimize this risk by ensuring the inclusion of different types of HCPs in the study unit. Additionally, to improve the quality of participation, we clearly outlined the study’s purpose, highlighting the clinical significance of polypharmacy and the benefits of deprescribing in mitigating ADEs.

Deprescribing, the practice of systematically reducing or discontinuing medications, is becoming increasingly important, particularly for older adults with limited life expectancy who often have multiple illnesses and complex treatment regimens. It reduces polypharmacy, and potential risks associated with it, such as adverse drug reactions and drug interactions, can also be minimized through deprescribing practices. Physical and cognitive safety may also be enhanced, and the deprescribing process helps ensure alignment with the care goals, especially for older adults with limited life expectancy [5, 6].

Due to their underlying medical conditions, older individuals are often prescribed multiple medications, making them more susceptible to ADEs, rehospitalization, and increased morbidity [1, 24]. Polypharmacy also raises the cost of managing unnecessary side effects and negatively impacts patient adherence to their treatment regimens. Therefore, to reduce the unintended adverse medication events associated with polypharmacy, it is important to evaluate healthcare professionals’ attitudes and practices toward deprescribing [22, 23]. To the best of our knowledge, no previous studies in this area have been conducted in the University of Gondar Medical Center. This study was therefore aimed at assessing the attitudes of healthcare professionals toward deprescribing for older adults with limited life expectancies.

In the current study, five factors related to healthcare professionals’ attitudes toward deprescribing for older adults with limited life expectancies were assessed: concern factors, burden factors, organizational factors, HCPs’ confidence, and patient involvement factors. The findings revealed that various, highly interrelated factors are statistically associated with HCPs’ attitudes towards deprescribing in this patient group. These results align with a systematic review by Carina Lund et al., which identified four key domains associated with HCPs’ perspectives on deprescribing for older adults with limited life expectancy, namely: (i) patient and family involvement, (ii) the importance of collaboration, (iii) HCPs’ confidence and competence, and (iv) the impact of organizational factors [9].

The central finding of this study is that although a slight majority of HCPs (52.1%) hold a favorable attitude toward deprescribing, there remains a pervasive apprehension regarding patient health deterioration. Furthermore, the high percentage of professionals (85.7%) reporting a need for extra training underscores a significant gap between the perceived clinical value of deprescribing and the confidence required to implement it in practice. Likewise, patient involvement factors (78.6%) were found to be common barriers to deprescribing of medications by HCPs. The findings of this study also confirmed that insufficient time and lack of training of HCPs on medication-related problems were factors that affect professionals’ attitudes towards deprescribing, while another study done by Krithikaa Nadarajan et al. commonly cited barriers towards deprescribing were unwillingness to stop medications prescribed by another doctor, lack of time, and insufficient knowledge [16]. While Krithikaa Nadarajan et al. identified unwillingness to stop medicines prescribed by others as a primary barrier, our study found that time constraints and perceived patient safety were more prominent. These differences may be attributed to our study being conducted in a resource-limited oncology ward in an Ethiopian teaching hospital, which likely presents a different profession mix and patient acuity level compared to the setting in the comparative study. In another study, most HCPs (87%) were less likely or not at all to be affected by a strong relationship between HCPs and their patients to make a deprescribing decision [4]. In another study done in Ethiopia, regarding the involvement factor, the majority of the respondents (68%) would like to be involved in making decisions about their medicines with their doctors [6].

In this study, most professionals (90.7%) believed that discontinuation of medications might have negative impacts on their patients’ health. Likewise, 48.5% of professionals are reluctant to stop or recommend stopping medicines initiated by senior physicians. This may be explained by the fact that there is no significant cooperation and discussion among health professionals during medication prescription. Another study done by junior doctors (32%) stated that they were reluctant to deprescribe medications, which was in contrast to the responses by the seniors, most of whom (94%) indicated no reluctance in deprescribing medications [4]. As the findings of the present study revealed, both gender and work experience were significantly associated with healthcare professionals’ attitudes toward deprescribing. A study conducted in [7] showed that older adults were willing to discontinue their medication as long as their doctor believed it was possible. This could enable HCPs to cooperate with their patients in deprescription decision processes.

The results from the current study revealed that work experience was the most frequently reported factor that is associated with HCP’s attitude towards deprescribing. This may be attributed to the fact that as HCPs gain seniority, they refine their clinical expertise and develop more proactive attitudes towards managing polypharmacy. This experience allows them to better appreciate the benefits of deprescribing in reducing medication complexity and preventing adverse ADEs in older adults with limited life expectancy. The findings of this study indicate that time is a significant factor associated with deprescribing practices. Most participants believed that if allotted sufficient time, they would be more likely to engage their patients in discussions regarding deprescribing. In another study, conducted by [13] Physicians and pharmacists had a substantial agreement on the number of medicines to deprescribe (CCC = 0.70; 95% CI: 0.58, 0.82), with a difference of 1.8 ± 2.0 total targeted medicines. For specific medicines, the agreement was moderate (ICC = 0.45, 95% CI: 0.32, 0.58) [12]. In our study, the primary associated factors of deprescribing were years of work experience. This contrasts with Study [18], which suggested that physician-pharmacist cooperation should be prioritized in the study area. Our results align with previous findings [4], suggesting that socio-demographic factors and professional experience significantly shape the attitudes of physicians, nurses, and pharmacists toward deprescribing in clinical settings.

Strengths and limitations

This study represents the first attempt to assess HCPs’ attitudes toward deprescribing for older adults with limited life expectancy in the study area. While we utilized a validated, multi-domain standardized tool, these findings should be interpreted with caution. The use of a self-administered, quantitative questionnaire limited our ability to explore the depth of HCPs’ attitudes; furthermore, the HATD questionnaire has not yet been validated within the unique cultural context of Ethiopia.

Several limitations must be considered when interpreting our results. First, the use of convenience sampling at the study site inherently limits external validity. Given the exploratory nature of this research, these findings are preliminary and not generalizable beyond the specific study ward. Consequently, future multi-center studies utilizing probability-based sampling are required to confirm these observations and to gain a comprehensive understanding of deprescribing attitudes and polypharmacy management among older adults in Ethiopian oncology units.

Another methodological limitation of this study is the dichotomization of Likert scale responses into binary categories (‘Agree’ vs. ‘Disagree/Neutral’). While this approach was deliberately chosen to provide clear, actionable insights for hospital administrators and to simplify the interpretation of barriers to deprescribing, it may have resulted in a loss of statistical power and nuance.

Conclusion

In this single-center cross-sectional survey, HCPs commonly reported concerns about deprescribing and a need for further training. Work experience and sex were associated with attitude classification in bivariate analysis, but these findings require cautious interpretation.

Recommendation

Further intervention studies with a potentially large number of HCPs working in different wards and a qualitative study are recommended to fully assess the deprescribing attitude in different disease categories and its prospective significance to Ethiopian older adults’ health. All HCPs should cooperate in the medication selection and prescribing process.

Furthermore, continuous professional development programs for HCPs are essential. These initiatives should focus on elucidating the risks of polypharmacy, the clinical benefits of deprescribing, and the critical role of interprofessional collaboration in the successful implementation of medication deprescribing. Additionally, the decision to utilize the original HATD framework was driven by the need for cross-cultural comparability; however, we acknowledge that the lack of local psychometric validation is a limitation that warrants dedicated future investigation.

Abbreviations

ADE

Adverse drug event

ADR

Adverse Drug Reaction

DIM

Department of Internal Medicine

HATD

Healthcare attitude towards deprescribing HCPs–Healthcare professionals

LLE

Life limited expectancy

LLI

Life limited illness

PIM

Potentially inappropriate medication

SPSS

Statistical Package for social science

UoG

University of Gondar

UoGCSH

University of Gondar Comprehensive and Specialized Hospital

Authors’ contributions

GG, HW, MK, and TYT drafted the study proposal. TYT, MA and ZDK wrote and critically reviewed the main manuscript text. AAA prepared the tables and a figure.

Funding

No funding was available.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

Before the study, written consent was obtained from the participants, and their information was kept confidential.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Clinical Trial

Not Applicable.