{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:08:16Z","timestamp":1790863696801,"version":"4.1.0"},"reference-count":52,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,3,8]]},"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Successful mechanisms for engaging patients in the deprescribing process remain unknown but may include: (1) triggering motivation to deprescribe by increasing patients\u2019 knowledge and concern about medications; (2) building capacity to taper by augmenting self-efficacy and (3) creating opportunities to discuss and receive support for deprescribing from a healthcare provider. We tested these mechanisms during theEliminating Medications through Patient Ownership of End Results (EMPOWER) () trial and investigated the contexts that led to positive and negative deprescribing outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A realist evaluation using a sequential mixed methods approach, conducted alongside the EMPOWER randomised clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community, Quebec, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>261 older chronic benzodiazepine consumers, who received the EMPOWER intervention and had complete 6-month follow-up data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Mailed deprescribing brochure on benzodiazepines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Motivation (intent to discuss deprescribing; change in knowledge test score; change in beliefs about the risk\u2013benefits of benzodiazepines, measured with the Beliefs about Medicines Questionnaire), capacity (self-efficacy for tapering) and opportunity (support from a physician or pharmacist).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The intervention triggered the motivation to deprescribe among 167 (n=64%) participants (mean age 74.6 years\u00b16.3, 72% women), demonstrated by improved knowledge (risk difference, 58.50% (95% CI 46.98% to 67.44%)) and increased concern about taking benzodiazepines (risk difference, 67.67% (95% CI 57.36% to 74.91%)). Those who attempted to taper exhibited increased self-efficacy (risk difference, 56.90% (95% CI 45.41% to 65.77%)). Contexts where the deprescribing mechanisms failed included lack of support from a healthcare provider, a focus on short-term quality of life, intolerance to withdrawal symptoms and perceived poor health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Deprescribing mechanisms that target patient motivation and capacity to deprescribe yield successful outcomes in contexts where healthcare providers are supportive, and patients do not have internal competing desires to remain on drug therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01148186\">NCT01148186<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-015959","type":"journal-article","created":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T20:20:14Z","timestamp":1493929214000},"page":"e015959","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":95,"title":["A realist evaluation of patients\u2019 decisions to deprescribe in the EMPOWER trial"],"prefix":"10.1136","volume":"7","clinical-trial-number":[{"clinical-trial-number":"nct01148186","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Philippe","family":"Martin","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, Universit\u00e9 de Montr\u00e9al, Montreal, Qu\u00e9bec, Canada"},{"name":"Institut Universitaire de G\u00e9riatrie de Montr\u00e9al, Montreal, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara","family":"Tannenbaum","sequence":"additional","affiliation":[{"name":"Institut Universitaire de G\u00e9riatrie de Montr\u00e9al, Montreal, Qu\u00e9bec, Canada"},{"name":"Universit\u00e9 de Montr\u00e9al, Faculties of Medicine and Pharmacy, Montreal, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,5,4]]},"reference":[{"key":"2025101811571376000_7.4.e015959.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i2893"},{"key":"2025101811571376000_7.4.e015959.2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.0324"},{"key":"2025101811571376000_7.4.e015959.3","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.131873"},{"key":"2025101811571376000_7.4.e015959.4","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-013-0106-8"},{"key":"2025101811571376000_7.4.e015959.5","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/jppr2003334323","article-title":"Deprescribing: achieving Better Health Outcomes for older people through reducing medications","volume":"33","author":"Woodward","year":"2003","journal-title":"J Pharm Pract Res"},{"key":"2025101811571376000_7.4.e015959.6","doi-asserted-by":"publisher","DOI":"10.1136\/eb-2012-100930"},{"key":"2025101811571376000_7.4.e015959.7","doi-asserted-by":"publisher","DOI":"10.2165\/0002512-200825120-00004"},{"key":"2025101811571376000_7.4.e015959.8","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/aft166"},{"key":"2025101811571376000_7.4.e015959.9","first-page":"CD007726","article-title":"Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia","volume":"3","author":"Declercq","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101811571376000_7.4.e015959.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2013.02.016"},{"key":"2025101811571376000_7.4.e015959.11","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L488"},{"key":"2025101811571376000_7.4.e015959.12","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1001\/jamainternmed.2014.949","article-title":"Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial","volume":"174","author":"Tannenbaum","year":"2014","journal-title":"JAMA Intern Med"},{"key":"2025101811571376000_7.4.e015959.13","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-007-0205-5"},{"key":"2025101811571376000_7.4.e015959.14","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12418"},{"key":"2025101811571376000_7.4.e015959.15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40360-015-0019-8","article-title":"Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review","volume":"16","author":"Pollmann","year":"2015","journal-title":"BMC Pharmacol Toxicol"},{"key":"2025101811571376000_7.4.e015959.16","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12916-016-0643-1","article-title":"RAMESES II reporting standards for realist evaluations","volume":"14","author":"Wong","year":"2016","journal-title":"BMC Med"},{"key":"2025101811571376000_7.4.e015959.17","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/bcp.12959","article-title":"Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis","volume":"82","author":"Johansson","year":"2016","journal-title":"Br J Clin Pharmacol"},{"key":"2025101811571376000_7.4.e015959.18","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/bcp.12975","article-title":"The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis","volume":"82","author":"Page","year":"2016","journal-title":"Br J Clin Pharmacol"},{"key":"2025101811571376000_7.4.e015959.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5205"},{"key":"2025101811571376000_7.4.e015959.20","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13702."},{"key":"2025101811571376000_7.4.e015959.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2011.03591.x"},{"key":"2025101811571376000_7.4.e015959.22","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-200206000-00009"},{"key":"2025101811571376000_7.4.e015959.23","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200522090-00004"},{"key":"2025101811571376000_7.4.e015959.24","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.archger.2007.01.018","article-title":"Effectiveness and safety of hypnotic drugs in the treatment of insomnia in over 70-year old people","volume":"44","author":"Cotroneo","year":"2007","journal-title":"Arch Gerontol Geriatr"},{"key":"2025101811571376000_7.4.e015959.25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.3109\/13685538.2011.626819","article-title":"Effect of age, education and health status on community dwelling older men\u2019s health concerns","volume":"15","author":"Tannenbaum","year":"2012","journal-title":"Aging Male"},{"key":"2025101811571376000_7.4.e015959.26","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050059"},{"key":"2025101811571376000_7.4.e015959.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006544","article-title":"Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis","volume":"4","author":"Anderson","year":"2014","journal-title":"BMJ Open"},{"key":"2025101811571376000_7.4.e015959.28","doi-asserted-by":"crossref","unstructured":"Pawson R . The science of evaluation: a realist manifestoAIA. Sage 2013.","DOI":"10.4135\/9781473913820"},{"key":"2025101811571376000_7.4.e015959.29","doi-asserted-by":"crossref","DOI":"10.1186\/1745-6215-14-80","article-title":"An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER study): protocol for a cluster randomized trial","volume":"14","author":"Martin","year":"2013","journal-title":"Trials"},{"key":"2025101811571376000_7.4.e015959.30","unstructured":"Tannenbaum C , Martin P . Sedative-Hypnotic medication De-Prescribing brochure. Montr\u00e9al Iudgd,2014. http:\/\/www.criugm.qc.ca\/fichier\/pdf\/BENZOeng.pdf"},{"key":"2025101811571376000_7.4.e015959.31","unstructured":"Hein G . Institute for inquiry constructivist learning theory. Institute for Inquiry available\u00a0. 1991 http:\/\/wwwexploratoriumedu\/ifi\/resources\/constructivistlearninghtmlS"},{"key":"2025101811571376000_7.4.e015959.32","doi-asserted-by":"publisher","DOI":"10.1177\/001872675400700202"},{"key":"2025101811571376000_7.4.e015959.33","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"key":"2025101811571376000_7.4.e015959.34","unstructured":"JW C , P-C V . Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications, 2007."},{"key":"2025101811571376000_7.4.e015959.35","doi-asserted-by":"publisher","DOI":"10.1080\/08870449908407311"},{"key":"2025101811571376000_7.4.e015959.36","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.24.3.281"},{"key":"2025101811571376000_7.4.e015959.37","doi-asserted-by":"crossref","unstructured":"McDowell I . Measuring health: a guide to rating scales and questionnaires. 3rd ed. New York, NY: Oxford University Press; US, 2006.","DOI":"10.1093\/acprof:oso\/9780195165678.003.0001"},{"key":"2025101811571376000_7.4.e015959.38","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200006)23:3<246::AID-NUR9>3.0.CO;2-H"},{"key":"2025101811571376000_7.4.e015959.39","doi-asserted-by":"crossref","unstructured":"Ellis P . The Essential Guide to effect sizes: statistical Power, Meta-Analysis, and the interpretation of Research results. Cambridge: Cambridge University Press, 2010.","DOI":"10.1017\/CBO9780511761676"},{"key":"2025101811571376000_7.4.e015959.40","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025101811571376000_7.4.e015959.41","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c4587"},{"key":"2025101811571376000_7.4.e015959.42","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305285708"},{"key":"2025101811571376000_7.4.e015959.43","unstructured":"Prochaska J . Transtheoretical Model of Behavior Change. In: Gellman M , Turner JR , eds. Encyclopedia of behavioral medicine New York NY: Springer, 2013."},{"key":"2025101811571376000_7.4.e015959.44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2005.01139.x"},{"key":"2025101811571376000_7.4.e015959.45","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.476"},{"key":"2025101811571376000_7.4.e015959.46","unstructured":"Sunny C , McDonald DW , Landay JA . Theory-driven design strategies for technologies that support behavior change in everyday life. \u00a0New York NY: ACM."},{"key":"2025101811571376000_7.4.e015959.47","unstructured":"Johnson B , Christensen LB . Educational research: quantitative, qualitative, and mixed approaches. 5th ed, 2014."},{"key":"2025101811571376000_7.4.e015959.48","first-page":"924","article-title":"Thinking through the medication list - appropriate prescribing and deprescribing in robust and frail older patients","volume":"41","author":"Hilmer","year":"2012","journal-title":"Aust Fam Physician"},{"key":"2025101811571376000_7.4.e015959.49","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.0328"},{"key":"2025101811571376000_7.4.e015959.50","doi-asserted-by":"publisher","DOI":"10.1037\/h0024835"},{"key":"2025101811571376000_7.4.e015959.51","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0237-x"},{"key":"2025101811571376000_7.4.e015959.52","unstructured":"Pawson R , Tilley N . Realistic evaluation. London: SAGE, 1997."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-015959","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:57:22Z","timestamp":1760813842000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-015959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,5,4]]},"published-print":{"date-parts":[[2017,4]]}},"alternative-id":["10.1136\/bmjopen-2017-015959"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-015959","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4]]}}}