Choosing Wisely Campaign: Valuable For Providers Who Knew About It, But Awareness Remained Constant, 2014–17

Abstract

Together with physician specialty societies, the Choosing Wisely® campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. The surveys included questions on the factors driving that use, physicians' comfort in having conversations with patients about that use, and physicians' exposure to the Choosing Wisely campaign. Despite continued publicity and physician outreach efforts, there were no significant changes between 2014 and 2017 in awareness of the campaign among physicians (awareness increased from 21 percent to 25 percent) or physician-reported difficulty in talking to patients about avoiding a low-value service (42 percent reported that such conversations had gotten harder in 2014, and 46 percent did so in 2017). Barriers to the adoption of recommendations included malpractice concerns, patient demand and satisfaction, and physicians' desire for more information to reduce uncertainty. Multifaceted interventions that reinforce guidelines through personalized education, follow-up, and feedback, as well as aligned financial incentives, should be pursued to reduce the use of low-value services.

Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

“…This can be very challenging, however, due to the complexity of insurance coverage. Utilize choosing wisely and other society recommendations to avoid low‐value care …”

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

“…and "just to be safe" (78%). [34] Egerton-Warburton et al [35] found that over half of 1029 emergency physicians in the study reduced their implicit "test threshold" well below the explicit threshold set using empirical data on test accuracy and risk of harm from the disease, due to their discomfort with diagnostic uncertainty. [35] Coon et al [16] also highlighted the "shotgun approach" [16] of ordering a broad range of tests and hoping for a positive result somewhere, which is often used in situations of diagnostic uncertainty.…”

“…This factor was cited in 22 articles. In the 2017 American Board of Internal Medicine Foundation survey, [34] among the commonest reasons for ordering low value tests were desire to reduce uncertainty (84%)…”

“…Van der Weijden et al [37] noted that not only were anxious patients more likely to request tests, but general practitioners conscious of long term relationships with patients were more likely to meet these requests. In the 2014 and 2017 American Board of Internal Medicine survey [34], a large proportion of participants cited desire to keep patients happy, patient's insistence, and the idea that patients should make the nal decision, as reasons for ordering tests. Gogineni et al [70] and Gri th et al [71] showed that clinicians were more likely to acquiesce to patient demands for tests the clinician judged as unnecessary if patients threatened to see another clinician.…”

Older Adults’ Perceptions of Healthcare Overuse

“…3 Choosing Wisely has garnered impressive support from both clinician societies and consumer advocacy groups, such as Consumer Reports, in developing a collaborative approach to tackle overuse. Nevertheless, widespread awareness and implementation have been difficult to achieve, 4,5 and patient engagement and understanding of overuse remain challenging.…”