CHARMER (CompreHensive geriAtRician-led Medication Review) - Developing a Core Outcome Set for hospital deprescribing trials: a modified Delphi study

We will develop a core outcome set (COS) for hospital deprescribing trials for patients under the care of a geriatrician.

We will conduct a modified Delphi study involving all relevant stakeholders (patients, carers, healthcare practitioners, managers and academics), who will help to decide which outcomes to include in the COS and how these should be measured.

A modified Delphi comprises three phases. In the first phase, we will develop a list of potentially relevant outcomes for consideration in the COS, drawing on published research and expertise of the CHARMER team including PPI (patient and public involvement) members. In the second phase, we will conduct a three-round Delphi survey to understand what the most important outcomes are from the perspective of all relevant stakeholders. In the third phase, we will conduct multi-stakeholder workshops to decide which outcomes to include in the COS and ensure the feasibility of implementing the proposed COS within a hospital deprescribing trial.


Professor Debi Bhattacharya (University of East Anglia, Co-Principal Investigator)
Professor David Wright (University of East Anglia, Co-Principal Investigator)
Dr Sion Scott (University of East Anglia)
Dr Jo Taylor (University of York)
Dr Jackie Martin-Kerry (University of York)
Dr Martyn Patel (Norfolk and Norwich University Hospitals NHS Foundation Trust)
Professor David Alldred (University of Leeds)
Professor Miles Witham (University of Newcastle)
Dr Victoria Keevil (Addenbrookes Hospital)
Dr David Turner (University of East Anglia)
Wendy Bradley (PPI member)
Jas Jayasooriya (PPI member)
Katherine Murphy (PPI member)
Doreen Pegg (PPI member)
Ms Bethany Atkins (University of East Anglia)
Dr Allan Clark (University of East Anglia)
Dr Ian Gibson (University of East Anglia)
Ms Caroline Smith (University of East Anglia)
Ms Caroline Hill (University of East Anglia)
Associate Professor Ian Kellar (University of Leeds)
Dr Erika Sims (University of East Anglia)
Ms Jessica Fairfax (University of York)

Further Study Information

Current Stage: Ongoing
Date: September 2020 - August 2021
Funding source(s): National Institute for Health Research (NIHR) Programme Grants for Applied Research stream [NIHR PGfAR 200874]

Health Area

Disease Category: Health care of older people

Disease Name: Polypharmacy, Deprescribing

Target Population

Age Range: 65 - 100

Sex: Either

Nature of Intervention: Drug

Stakeholders Involved

- Clinical experts
- Consumers (caregivers)
- Consumers (patients)
- Researchers
- Service providers
- Service users

Study Type

- COS for clinical trials or clinical research


- Consensus meeting
- Delphi process
- Literature review
- Semi structured discussion

Phase 1:
We will identify existing published core outcome sets for polypharmacy and medication reviews, and systematic reviews of deprescribing trials. We will extract outcomes and review the list to ensure all outcomes are relevant, merge / delete overlapping outcomes, identify other relevant outcomes that are missing, and develop definitions for each outcome in the list. The CHARMER PPI members will also help the team to develop the list, and refine the medical and the plain language terms as necessary.

Phase 2:
We will undertake three rounds of a Delphi survey to reach stakeholder consensus about which outcomes are the most important to include in the core outcome set. Stakeholders will include patients and informal carers; healthcare practitioners caring for older people in hospital (geriatricians, pharmacists, nurses, physiotherapists, occupational therapists); hospital managers (e.g. service managers, medical directors, specialty lead, or contracts person) and academic researchers with an interest in older people’s medicine and/or deprescribing. We will recruit a minimum of 40 participants to the healthcare professional group (to ensure sufficient numbers of different professions within this group), and a minimum of 30 participants for each of the other stakeholder groups (total minimum=130).

Phase 3:
We will conduct stakeholder workshops to help finalise the outcomes in the core outcome set, explore the barriers and enablers to implementing the COS, and identify trial design features (e.g. using routinely collected data) and data collection tools and processes (e.g. patient follow-up) to facilitate this.

We will convene two online workshops each with 10-12 stakeholder participants representing the four groups participating in Phase 1 (total n=20-24). A minimum of two participants will represent each stakeholder group in each workshop.

We will use information from the workshops to finalise the core outcome set, including making recommendations about how to measure the outcomes included.

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