Choosing Wisely® in Preventive Medicine

Livingston, Catherine J.; Freeman, Randall J.; Mohammad, Amir; Costales, Victoria C.; Titus, Tisha M.; Harvey, Bart J.; Sherin, Kevin

doi:10.1016/j.amepre.2016.03.009

Cited by 21 publications

(6 citation statements)

References 35 publications

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“…Although the majority of professional organizations (36 of 42) in developed countries do not recommend or recommend against national mass screening programs, they disagree about opportunistic and selective screening (Appendix Figure 1). Some professional North American organizations recommend against routine PSA-based screening (American College of Preventive Medicine 2016, 9 American Academy of Family Physicians 2012, 10 Canadian Task Force Preventive Health Care 2014 11 ), whereas others suggest shared decision making (SDM) to help patients decide (U.S. Preventive Services Task Force 2018, 5,6 American Urological Association 2013 (confirmed in 2015), 12 American College of Physicians 2015, 13 National Comprehensive Cancer Network 2018, 14 American Cancer Society 2016 15 ). The final recommendation statement 5 from the U.S. Preventive Services Task Force includes new support for SDM among asymptomatic men in the general U.S. population who are aged 55 to 69 years.…”

Section: Contextmentioning

confidence: 99%

Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis

Ivlev

Jeřábková

Mishra

et al. 2018

American Journal of Preventive Medicine

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Context: Although screening recommendations for prostate cancer using prostate-specific antigen testing often include shared decision making, the effect of patient decision aids on patients’ intention and uptake is unclear. This study aimed to review the effect of decision aids on men’s screening intention, screening utilization, and the congruence between intentions and uptake. Evidence acquisition: Data sources were searched until April 6, 2018, and included MEDLINE, Scopus, CENTRAL, CT.gov, Cochrane report, PsycARTICLES, PsycINFO, and reference lists. This study included RCTs and observational studies of decision aids that measured prostate screening intention or behavior. The analysis was completed in April 2018. Evidence synthesis: Eighteen studies (13 RCTs, four before–after studies, one non-RCT) reported data on screening intention for ≅8,400 men and screening uptake for 2,385 men. Compared with usual care, the use of decision aids in any format results in fewer men (aged ≥40 years) planning to undergo prostate-specific antigen testing (risk ratio=0.88, 95% CI=0.81, 0.95, p=0.006, I2=66%, p<0.001, n=8). Many men did not follow their screening intentions during the first year after using a decision aid; however, most men who were planning to undergo screening did so (probability that men who wanted to be screened would receive screening was 95%). Conclusions: Integration of decision aids in clinical practice may result in a decrease in the number of men who elect prostate-specific antigen testing, which may in turn reduce screening uptake. To ensure high congruence between intention and screening utilization, providers should not delay the shared decision-making discussion after patients use a decision aid.

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Section: Contextmentioning

confidence: 99%

Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis

Ivlev

Jeřábková

Mishra

et al. 2018

American Journal of Preventive Medicine

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“…To our knowledge, this Top-5 list in internal medicine has been compiled with one of the highest numbers of participating physicians. [40][41][42][43][44][45] Moreover, the fact that 44% of participants were residents is original and encouraging. Given that today's residents will be the prescribers of tomorrow, it seems important to raise early awareness of the problem of overmedicalization.…”

Section: 36mentioning

confidence: 92%

The French Society of Internal Medicine’s Top-5 List of Recommendations: a National Web-Based Survey

Peiffer-Smadja

Bauvois

Chilles³

et al. 2019

J GEN INTERN MED

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“…Specifically, the HbA 1c threshold in the American Geriatrics Society (AGS) diabetes recommendation was changed from 7.5% to 7.0% to better align with the health systems’ existing quality measures. The American College of Preventive Medicine recommendation against PSA testing to screen for prostate cancer was narrowed to focus on men age 75 years and older due to a newer recommendation from the US Preventive Services Task Force for shared decision-making around PSA testing for men aged 55 to 69 years and because no professional guidelines recommend PSA screening after age 75 years . The AGS recommendation around overuse of benzodiazepines and sedative-hypnotics was modified to focus on just insomnia and anxiety to better align with the availability of administrative data.…”

Section: Methodsmentioning

confidence: 99%

Using Behavioral Economics to Reduce Low-Value Care Among Older Adults

Kullgren,

Kim,

Slowey

et al. 2024

JAMA Intern Med

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ImportanceUse of low-value care is common among older adults. It is unclear how to best engage clinicians and older patients to decrease use of low-value services.ObjectiveTo test whether the Committing to Choose Wisely behavioral economic intervention could engage primary care clinicians and older patients to reduce low-value care.Design, Setting, and ParticipantsStepped-wedge cluster randomized clinical trial conducted at 8 primary care clinics of an academic health system and a private group practice between December 12, 2017, and September 4, 2019. Participants were primary care clinicians and older adult patients who had diabetes, insomnia, or anxiety or were eligible for prostate cancer screening. Data analysis was performed from October 2019 to November 2023.InterventionClinicians were invited to commit in writing to Choosing Wisely recommendations for older patients to avoid use of hypoglycemic medications to achieve tight glycemic control, sedative-hypnotic medications for insomnia or anxiety, and prostate-specific antigen tests to screen for prostate cancer. Committed clinicians had their photographs displayed on clinic posters and received weekly emails with alternatives to these low-value services. Educational handouts were mailed to applicable patients before scheduled visits and available at the point of care.Main Outcomes and MeasuresPatient-months with a low-value service across conditions (primary outcome) and separately for each condition (secondary outcomes). For patients with diabetes, or insomnia or anxiety, secondary outcomes were patient-months in which targeted medications were decreased or stopped (ie, deintensified).ResultsThe study included 81 primary care clinicians and 8030 older adult patients (mean [SD] age, 75.1 [7.2] years; 4076 men [50.8%] and 3954 women [49.2%]). Across conditions, a low-value service was used in 7627 of the 37 116 control patient-months (20.5%) and 7416 of the 46 381 intervention patient-months (16.0%) (adjusted odds ratio, 0.79; 95% CI, 0.65-0.97). For each individual condition, there were no significant differences between the control and intervention periods in the odds of patient-months with a low-value service. The intervention increased the odds of deintensification of hypoglycemic medications for diabetes (adjusted odds ratio, 1.85; 95% CI, 1.06-3.24) but not sedative-hypnotic medications for insomnia or anxiety.Conclusions and RelevanceIn this stepped-wedge cluster randomized clinical trial, the Committing to Choose Wisely behavioral economic intervention reduced low-value care across 3 common clinical situations and increased deintensification of hypoglycemic medications for diabetes. Use of scalable interventions that nudge patients and clinicians to achieve greater value while preserving autonomy in decision-making should be explored more broadly.Trial RegistrationClinicalTrials.gov Identifier: NCT03411525

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Choosing Wisely® in Preventive Medicine

Cited by 21 publications

References 35 publications

Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis

Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis

The French Society of Internal Medicine’s Top-5 List of Recommendations: a National Web-Based Survey

Using Behavioral Economics to Reduce Low-Value Care Among Older Adults

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