Exploring Sex, Gender, and Gender-Related Sociocultural Factors in Clinical Decision-Making for Older Adults Using a Prescribing Cascade Vignette: A Transnational Qualitative Study.

Autor: Kthupi A; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Rochon PA; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Santini S; Centre for Socio-Economic Research on Aging IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124, Ancona, Italy., Paoletti L; Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'invecchiamento, IRCCS INRCA, 60127, Ancona, Italy., Mason R; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada., McCarthy LM; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada.; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada., Carrieri B; Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'invecchiamento, IRCCS INRCA, 60127, Ancona, Italy., Dalton K; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland., Li J; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada., Sivayoganathan K; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada.; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada., Borhani P; Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Sternberg SA; Maccabi Healthcare Services, Tel Aviv, Israel., Zwas DR; Hadassah University Medical Center, Jerusalem, Israel., Savage RD; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada. Rachel.Savage@wchospital.ca.; Institute for Health Planning, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Rachel.Savage@wchospital.ca.
Jazyk: angličtina
Zdroj: Drugs & aging [Drugs Aging] 2024 Dec; Vol. 41 (12), pp. 977-988. Date of Electronic Publication: 2024 Nov 27.
DOI: 10.1007/s40266-024-01158-1
Abstrakt: Background: Despite growing awareness of sex differences in inappropriate prescribing among older adults, including the initiation of problematic prescribing cascades, the impact of gender bias remains largely unexplored.
Objectives: We explored how a patient's sex and gender-related sociocultural factors influence physicians' prescribing decisions, potentially leading to prescribing cascades in older adults. A secondary objective was to explore whether and how physician sex affected prescribing decisions for female and male patients.
Methods: Physicians in Canada and Italy were presented with a clinical vignette describing an older male or female patient on amlodipine presenting with peripheral edema. Physicians were interviewed using the 'think-aloud' method to describe their treatment considerations. Thematic multi-site analysis was used to analyze the data.
Results: Of 30 physicians, only two considered prescribing a diuretic for an older female patient. Most physicians identified amlodipine as the cause of the edema and adjusted or substituted the medication, often making these treatment decisions without considering sex- and gender-related sociocultural factors. When prompted, physicians acknowledged the relevance of these factors, but their responses varied. Some adapted their treatment plans, noting the challenges of managing edema, particularly for female patients, whereas others did not incorporate these considerations. Interestingly, some physicians adjusted their plans based on gender-related factors yet still stated that gender did not influence their treatment decisions. No variations in treatment decisions based on physician sex were observed.
Conclusion: The study reveals a gap between physicians' recognition of gender-related sociocultural factors and their consistent integration into clinical decision-making, highlighting the need for more nuanced approaches in prescribing practices.
Competing Interests: Declarations. Funding: The iKASCADE project is funded by a GENDER NET Plus grant (GNP-1782) in partnership with the Canadian Institutes of Health Research (Institute of Gender & Health and Institute of Aging) GNP-161902, the Irish Research Council GNP-172, Ministero della Salute Italiano RRC-2019-2366768 (Italy), and the Ministry of Science, Technology and Space (Israel). The study sponsors did not participate in the design and conduct of the study, data collection or management, preparation, review, approval of the manuscript, or the decision to submit the manuscript for publication. Competing interests: The authors have no conflicts of interest that are relevant to the content of this study. Ethics approval: This study received ethics approval from Women’s College Hospital in Canada (REB # 2019-0030-E) and from the Italian National Institute of Health and Science on Ageing in Italy (REB # n.22010 of 31.03.2022). Consent for publication: Not applicable. Data availability statements: The data that support the findings of this study are available from the corresponding author upon reasonable request. Code availability: Not applicable. Consent to Participate: Informed consent was obtained from all study participants. Author contributions: The study was conceptualized by RDS, RM and PAR, and the methodology was designed by RDS, RM, PAR, PB, BC, KD, AL, JL, LMM, LP, SAS, SSt DRZ, and AK. AK prepared the original draft of the manuscript. All authors critically reviewed and edited the manuscript. The final manuscript was approved by all authors. Funding was acquired for this work by PAR.
(© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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