Summary

The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely® campaign in 2012 to encourage dialogue between clinicians and patients about evidence-based necessary care.1 The campaign, aimed at both clinicians and patients, publishes materials to reduce the use of tests and treatments that offer little to no benefit for patients (low-value healthcare practices). Examples include lists that highlight low-value practices in different healthcare areas, and patient materials with accessible information to help people discuss their treatment and care options with clinicians. Initial findings suggest that the Choosing Wisely® initiatives in cancer care are reducing the use of unnecessary tests and treatments in practice.2 3

 

Challenge

Tests and treatments that offer little to no benefit for patients, also known as low-value healthcare practices, lead to wasted healthcare resources, unnecessary medical risks and increased stress for patients and their families.4-7 Clinicians may overestimate the clinical benefit and effectiveness of certain tests and treatments – for example, in the case of technological advances and new treatments for people with advanced cancer.8 People with cancer may also request low-value tests or treatments, possibly because they believe ‘more healthcare is better than less’.9

Solution

The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely® campaign in 2012 to combat the overuse of low-value tests and treatments by encouraging dialogue between clinicians and patients about evidence-based necessary care.1 The campaign publishes materials aimed at clinicians and patients, including:

  • Choosing Wisely® lists highlighting low-value tests and treatments in different healthcare areas, including cancer care.1 These lists are created by specialty societies and disseminated by the campaign with the aim of encouraging patients and clinicians to question and discuss low-value healthcare practices
  • Choosing Wisely® patient-friendly materials with accessible information about tests/treatments and health conditions, including cancer, to help people communicate effectively with their clinicians about appropriate treatment and care options.10 11 These resources are available as brochures, wallet cards, rack cards and videos.

The Choosing Wisely® materials for cancer care span the full patient pathway, with recommendations for screening, diagnosis, treatment, follow-up and palliative care.12-22 All recommendations are publicly available on the Choosing Wisely® website and mobile application.23

 

What has it achieved?

  • Choosing Wisely® has partnered with more than 80 specialty societies in the United States, and expanded to over 20 other countries, to publish 610 recommendations in different healthcare areas. It works with 70 consumer organisations, distributing more than 110 types of patient-friendly materials to millions of people around the world.11
    Choosing Wisely® in oncology

    The University of Texas MD Anderson Cancer Center provided a high number of blood transfusions linked to gynaecological cancer surgery.2 It retrained staff using Choosing Wisely® blood transfusion targets and:

    • halved the number of blood transfusions from 24% to 11% of patients (national average: 14% of patients)
    • saved an estimated 49 units of blood and $13,426 per month, without affecting patient outcomes.2

    The Banner MD Anderson Cancer Center in Arizona introduced an initiative to reduce imaging tests for people in remission from lymphoma, based on Choosing Wisely® recommendations to prevent the harmful over-testing of patients.3 Clinicians accessing the electronic health records of people with lymphoma received an automatic alert reminding them of the benefits and risks of imaging tests. Initial findings showed a decrease in the overall use of imaging from 48.3 to 25.3 scans a month.3

Next steps

The Choosing Wisely® campaign is an ongoing initiative that will continue publishing recommendations in collaboration with medical specialty societies.24 Additional future work includes:

  • working with healthcare system networks under the Transforming Clinical Practice Initiative to improve knowledge-sharing between healthcare systems and to implement Choosing Wisely® recommendations in practice
  • researching vulnerable populations and low-resource settings, beyond academic hospitals, to better understand how healthcare systems can reduce low-value services to improve healthcare despite limited funding.24

Further information

  • The Choosing Wisely® website
  • Choosing Wisely® materials for clinicians and patients
  • Papers outlining the impact of the Choosing Wisely® recommendations in the United States
  • An infographic outlining the results of the campaign
  •  case study on the University of Texas MD Anderson Cancer Center

References:

  1. Choosing Wisely®. Our mission. Available here: https://www.choosingwisely.org/our-mission/ [accessed: May 2019]
  2. Prescott LS, Taylor JS, Enbaya A, et al. 2019. Choosing Wisely: decreasing the incidence of perioperative blood transfusions in gynecologic oncology. Gynecol Oncol Available here: https://doi.org/10.1016/j.ygyno.2019.03.008
  3. Choosing Wisely®. 2016. American society of hematology to recognize Choosing Wisely champions at 58th annual meeting. [Updated 02/12/16] Available here: https://www.choosingwisely.org/american-society-of-hematology-to-recognize-choosing-wisely-champions/ [accessed: May 2019]
  4. Wolfson D, Santa J, Slass L. 2014. Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the Choosing Wisely campaign. Acad Med 89(7): 990-5
  5. Chassin MR, Galvin RW, National Roundtable on Health Care Quality. 1998. The urgent need to improve healthcare quality: Institute of Medicine national roundtable on health care quality. JAMA 280(11): 1000-05
  6. Emery DJ, Shojania KG, Forster AJ, et al. 2013. Overuse of Magnetic Resonance Imaging. JAMA Intern Med 173(9): 823-25
  7. Swensen SJ, Kaplan GS, Meyer GS, et al. 2011. Controlling healthcare costs by removing waste: what American doctors can do now. BMJ Qual Saf 20(6): 534-7
  8. Saletti P, Sanna P, Gabutti L, et al. 2018. Choosing wisely in oncology: necessity and obstacles. ESMO Open 3(5): e000382
  9. Carman KL, Maurer M, Yegian JM, et al. 2010. Evidence that consumers are skeptical about evidence-based health care. Health Aff (Millwood) 29(7): 1400-6
  10. Rand K. 2019. The Choosing Wisely campaign. AllCan Belgium Launch; 19/03/19; Brussels, Belgium
  11. Choosing Wisely®. 2016. Choosing Wisely: facts and figures. Philadelphia: Choosing Wisely
  12. Hahn C, Kavanagh B, Bhatnagar A, et al. 2014. Choosing Wisely: the American Society for Radiation Oncology’s top 5 list. Pract Radiat Oncol 4(6): 349-55
  13. Hicks LK, Bering H, Carson KR, et al. 2013. The ASH Choosing Wisely® campaign: five hematologic tests and treatments to question. Blood 122(24): 3879-83
  14. Schnipper LE, Smith TJ, Raghavan D, et al. 2012. American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology. J Clin Oncol 30(14): 1715-24
  15. Choosing Wisely® Canada. 2014. Ten Things Physicians and Patients Should Question. Available here: https://choosingwiselycanada.org/oncology/ [accessed: March 2019]
  16. Schnipper LE, Lyman GH, Blayney DW, et al. 2013. American Society of Clinical Oncology 2013 top five list in oncology. J Clin Oncol 31(34): 4362-70
  17. Mitera G, Earle C, Latosinsky S, et al. 2015. Choosing Wisely Canada cancer list: ten low-value or harmful practices that should be avoided in cancer care. J Oncol Pract 11(3): e296-303
  18. Cheung MC, Mittmann N, Earle CC, et al. 2018. Are we choosing wisely in lymphoma? Excessive use of surveillance CT imaging in patients with diffuse large B-cell lymphoma (DLBCL) in long-term remission. Clin Lymphoma Myeloma Leuk 18(1): e27-e34
  19. Consumer Reports. 2017. Imaging tests for melanoma: when you need tests for skin cancer and when you don't. Philadelphia: Choosing Wisely®
  20. Consumer Reports. 2017. Palliative care: support at any time during a serious illness. Philadelphia: Choosing Wisely®
  21. Consumer Reports. 2014. Screening tests for ovarian cancer: when you need them and when you don't. Philadelphia: Choosing Wisely®
  22. Consumer Reports. 2018. PET scans after cancer treatment: when you need them and when you don't. Philadelphia: Choosing Wisely®
  23. Choosing Wisely®. 2017. Choosing Wisely is now an app! [ Available here: https://www.choosingwisely.org/resources/updates-from-the-field/choosing-wisely-is-now-an-app/ [accessed: May 2019]
  24. Rand K. 2019. Interview with Marissa Mes at The Health Policy Partnership [telephone]. 18/07/19
  • Contact information:
  • Kelly Rand (Programme Officer, ABIM Foundation)
  • KRand@ABUM.org