Table 4.

Barriers to deprescribing

Barriers to deprescribing
Theme	Subtheme	TDF domain	Sample quotes
Organisation of healthcare	Clinician continuity	Social influences Environmental context and resources	"You can’t get in touch with your Doctor. It’s no good going to another Doctor that doesn’t understand that you’re coming off your morphine and how it’s affecting you.” P2 (Practice 3) “You never see the same doctor twice (…) unless you’re under one person all the time you could go haywire (…) That’s often the way when you see one doctor after another, your frequent doctor gets changed. They jump in too quick, if you’re under the care of one person then that person can really monitor you.” P1 (practice 2)
	Consultation constraints	Environmental context and resources	“We’re in tough times in primary care and pressure of demand is really, really high and so ad-hoc deprescribing is really difficult to do.” HCP1 (practice 1) "I think it might have been easier if I hadn’t done it (reviewed patient’s medicines) over the phone, it might have actually been easier with that patient in front of me, but I’ve got time limitations.” HCP2 (practice 1) “They haven’t got time you see; you go into the surgery and you’ve only 10 minutes (to see the GP).” IC3 (Practice 4)
	Perceived hierarchies	Social/professional role and identity	"I can’t remember the exact drug, but I can tell you it was a cardiology medication, and the resistance really was they’d been told, you know this Cardiologist had told them they needed it and they needed to have it lifelong.” HCP1(practice 4)
Communication clarity	Accessibility of terminology and information	Memory, attention and decision processes	"I think [patients] get a bit confused by the word deprescribing. It can be very much a clinical term. We need to accept that patients aren’t [always familiar with clinical terms] and so I would quite often call it something different.” HCP2 (practice 2) “My first impression was that [deprescribing] was something that was done to one, not something that you had an active say in. It was a decision that a healthcare professional took and told the patient about it.” P1 (practice 1)
	Sharing and understanding decisions	Memory, attention and decision processes Skills (interpersonal)	"I don't want them to say right we'll start reducing this, I need to know why and what’s going to happen with me.” P2 (practice 3) “They don’t explain what they’re trying to say to you. It’s as if oh we’ll see you next week, go on we’ll see you again later. It’s…not explained what they’re telling you…” P3 (practice 4).
Habits and fears	Medicines-taking habit	Emotion	"Because she [patient] panics. And she’s been on them such long-term and it becomes habit. And I think when you stop something that you’ve been doing for a long time you think ‘oh’, you panic straight away, you think ‘oh, it’s all going to go wrong, it’s all going to go wrong.” IC1 (practice 4).
	Fear of negative consequences of deprescribing	Emotion	“Yes, I was afraid. Because the morphine helped me with the pain and I knew each time I was coming down I was getting pain, so I just took paracetamol and then it just kept coming down I think it was about every month she wanted me to have a go at coming down.” P2 (practice 3).

TDF, Theoretical Domains Framework.