Consistent with our previous vignette-based experiment,4 we found high acceptance of a statin deprescribing recommendation among older adults. Participants had significantly lower agreement when the statins were originally prescribed by a cardiologist, when the hypothetical patient’s spouse had a stroke after stopping statin, and after viewing a poster visually displaying how a stroke occurs, compared to participants receiving no additional contextual information (control condition). The use of vignettes may under-estimate the effects of these types of factors as it is likely that people have stronger emotional responses to these types of situations in real life.

Previous research has shown that older adults and primary care practitioners are more hesitant to stop a medication that was initially prescribed by a specialist.5,6 While multiple prescribers may be necessary to ensure patients receive optimal care across multiple conditions, it can increase the complexity of engaging in deprescribing conversations.7

The vignettes in which the spouse had a stroke or the participant viewed an image showing what occurs during a stroke may have evoked an emotional response from participants. More research is needed regarding the influence of emotions (e.g., fear, worry, disgust) on deprescribing attitudes and decisions.

This study is limited by being an online experiment focused on simvastatin; it is not clear if our findings generalize to other preventive medications (antiplatelets or antihypertensives, for example).

This study provides evidence that different contextual factors can influence how patients think about statin deprescribing decisions. Clinicians should consider how a statin was started, in what setting, and by whom, as well as external factors that may increase patient concern when engaging in deprescribing conversations with patients.