Introduction: A multidisciplinary approach, whereby an integrated team of professionals from different disciplines and specialties comes together to reach a combined decision on a complex situation, is considered the gold standard for care of people with advanced dementia living in long-term care.
Aim: This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate.
Methods: Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and anticholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types.
Results: Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care.
Conclusion: Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives, and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.