Exploring sex, gender, and gender-related sociocultural factors in clinical decision-making for older adults using a prescribing cascade vignette: A transnational qualitative study

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dc.check.date2025-11-27en
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisheren
dc.contributor.authorKthupi, Alteaen
dc.contributor.authorRochon, Paula A.en
dc.contributor.authorSantini, Saraen
dc.contributor.authorPaoletti, Lucaen
dc.contributor.authorMason, Robinen
dc.contributor.authorMcCarthy, Lisa M.en
dc.contributor.authorCarrieri, Barbaraen
dc.contributor.authorDalton, Kieranen
dc.contributor.authorLi, Joyceen
dc.contributor.authorSivayoganathan, Kawsikaen
dc.contributor.authorBorhani, Paryaen
dc.contributor.authorSternberg, Shelley A.en
dc.contributor.authorZwas, Donna R.en
dc.contributor.authorSavage, Rachel D.en
dc.contributor.authorRochon, Paula A.en
dc.contributor.authorGurwitz, Jerryen
dc.contributor.authorCherubini, Antonioen
dc.contributor.authorOnder, Grazianoen
dc.contributor.authorPegreffi, Francescoen
dc.contributor.authorPetrovic, Mirkoen
dc.contributor.authorO’Mahony, Denisen
dc.contributor.authorSternberg, Shelley A.en
dc.contributor.funderCanadian Institutes of Health Researchen
dc.contributor.funderIrish Research Councilen
dc.contributor.funderMinistero della Saluteen
dc.contributor.funderMinistry of Innovation, Science and Technologyen
dc.contributor.funderHorizon 2020en
dc.date.accessioned2024-12-19T10:41:09Z
dc.date.available2024-12-19T10:41:09Z
dc.date.issued2024-11-27en
dc.description.abstractBackground: 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.en
dc.description.sponsorshipHorizon 2020 (GENDER NET Plus grant GNP-1782)); Canadian Institutes of Health Research (Institute of Gender & Health and Institute of Aging GNP-161902); Irish Research Council (GNP-172); Ministero della Salute Italiano (RRC-2019-2366768)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationKthupi, A., Rochon, P. A., Santini, S., Paoletti, L., Mason, R., McCarthy, L. M., Carrieri, B., Dalton, K., Li, J., Sivayoganathan, K. and Borhani, P. (2024) 'Exploring sex, gender, and gender-related sociocultural factors in clinical decision-making for older adults using a prescribing cascade vignette: A transnational qualitative study', Drugs & Aging, 41, pp 977-988. https://doi.org/10.1007/s40266-024-01158-1en
dc.identifier.doihttps://doi.org/10.1007/s40266-024-01158-1en
dc.identifier.eissn1179-1969en
dc.identifier.endpage988en
dc.identifier.issn1170-229Xen
dc.identifier.journaltitleDrugs & Agingen
dc.identifier.startpage977en
dc.identifier.urihttps://hdl.handle.net/10468/16739
dc.identifier.volume41en
dc.language.isoenen
dc.publisherSpringer Natureen
dc.relation.ispartofDrugs & Agingen
dc.rights© 2024, the Authors, under exclusive licence to Springer Nature Switzerland AG. This version of the paper has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s40266-024-01158-1en
dc.subjectGender-related sociocultural factorsen
dc.subjectSex differencesen
dc.subjectInappropriate prescribingen
dc.subjectProblematic prescribing cascadesen
dc.titleExploring sex, gender, and gender-related sociocultural factors in clinical decision-making for older adults using a prescribing cascade vignette: A transnational qualitative studyen
dc.typeArticle (peer-reviewed)en
oaire.citation.issue12en
oaire.citation.volume41en
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