Table 2.

Socio-contextual factors to consider when deprescribing^a

Determinant	Key Components of Assessment	Example
Clinical	Assess the complex comorbid conditions affecting a patient, the risks/benefits of medications used to treat each of these, and the adverse drug events exacerbated by specific agents. Identify medication benefits vs harms and expected time to benefit in the context of diagnosis, and symptom management goals (e.g., decreasing pruritis). Prescribing cascades (e.g., proton pump inhibitor for aspirin use) should also be noted along with medications that have equivocal evidence for benefit including preventive agents such as statins etc. Finally, available alternatives should be discussed.	Understand the role of each medication and assess its use in the context of patient circumstances, e.g., diuretics in an anuric patient.
Psychologic	Determine anxiety/worry about medications or conditions that affect deprescribing and assess perceptions and/or knowledge regarding treatments (e.g., perceptions of a need for intensive glucose or BP control, or intensive phosphate control). Any anxieties or distress that arises from possible discontinuation of certain medications should be addressed, and patient-identified prioritization of treatment goals. This includes an understanding of health literacy, cognitive function, goals of care (e.g., relief of symptoms, overall function), decisional self-efficacy etc.	Prioritizing volume management and dyspnea reduction over phosphate control; exploring anxieties regarding stroke and other cardiovascular event concerns in individuals with nonindicated long-term anticoagulant use.
Social	Assess caregiver and other loved ones’ effect on medication decision making, which may manifest as gatekeeping (e.g., concerns by family members regarding discontinuation of certain medications); assess other social support concerns and other social responsibilities (e.g., caring for another family member), which may limit time and opportunities for self-care. Family and other loved ones may need to serve as partners in deprescribing plans, while centering patient values and priorities in this process.	Concerns among caregivers that deprescribing agents such as sleep aids etc. will increase their caregiving needs.
Financial	Carefully assess costs of medications in the context of health insurance coverage and access including out of pocket costs for nonprescription medications are important provide reassurance that deprescribing should not be driven exclusively by cost-reduction incentives.	Consider when Tums could be safely substituted for more expensive phosphorous binders.
Physical	Assess frailty, changes in dexterity, vision, cognition, and the challenge of taking certain medications (e.g., those more complex to administer including injectables) is an important consideration among older adults. This also may include considerations of how changes in dexterity or memory may impair the ability to adhere to medications before and after dialysis or meals.	Considering prepackaged medications for each day of week.

^aThese five determinants of deprescribing were obtained from the deprescribing rainbow, a conceptual framework on the importance of patient context in deprescribing (76).