Patient and family involvement in Choosing Wisely initiatives: a mixed methods study

Abstract

Background Patients are important stakeholders in reducing low-value care, yet mechanisms for optimizing their involvement in low-value care remain unclear. To explore the role of patients in the development and implementation of Choosing Wisely recommendations to reduce low-value care and to assess the likelihood that existing patient resources will change patient health behaviour. Methods Three phased mixed-methods study: 1) content analysis of all publicly available Choosing Wisely clinician lists and patient resources from the United States of America and Canada. Quantitative data was summarized with frequencies and free text comments were analyzed with qualitative thematic content analysis; 2) semi-structured telephone interviews with a purposive sample of representatives of professional societies who created Choosing Wisely clinician lists and members of the public (including patients and family members). Interviews were transcribed verbatim, and two researchers conducted qualitative template analysis; 3) evaluation of Choosing Wisely patient resources. Two public partners were identified through the Calgary Critical Care Research Network and independently answered two free text questions “would this change your health behaviour” and “would you discuss this material with a healthcare provider”. Free text data was analyzed by two researchers using thematic content analysis. Results From the content analysis of 136 Choosing Wisely clinician lists, six reported patient involvement in their development. From 148 patient resource documents that were mapped onto a conceptual framework (Inform, Activate, Collaborate) 64% described patient engagement at the level of Inform (educating patients). From 19 interviews stakeholder perceptions of patient involvement in reducing low-value care were captured by four themes: 1) impact of perceived power dynamics on the discussion of low-value care in the clinical interaction, 2) how to communicate about low-value care, 3) perceived barriers to patient involvement in reducing low-value care, and 4) suggested strategies to engage patients and families in Choosing Wisely initiatives. In the final phase of work in response to the question “would this change your health behaviour” two patient partners agreed ‘yes’ on 27% of patient resources. Conclusions Opportunities exist to increase patient and family participation in initiatives to reduce low-value care.

Co-designed and consensus based development of a quality improvement checklist of patient and family-centered actionable processes of care for adults with persistent critical illness

“…Adults who transition to persistent or chronic critical illness have complex recovery and rehabilitative care needs requiring a shift in care goals and care planning [1]. Treatments considered important to the safe and effective management of acute critical illness such as continuous hemodynamic monitoring, frequent blood testing, and use of sedative drugs may be comparatively less appropriate in patients with persistent or chronic critical illness and equate to low-value care [2]. Despite awareness of differences in care needs and the known burden of persistent and chronic critical illness on patients, their family members, and the healthcare system, [3], there are few tools (e.g., checklists or protocols) or quality metrics specific to this patient population to aid in the delivery of high quality care.…”

Patient-centered high-value integrated care

“…Available at www.choosingwisely.org , it is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments, and procedures [ 3 ]. To be effective, it is suggested that low-value versus high-value care should be discussed during the clinical encounters between patients, their families, and physicians [ 4 ]. In the discussions, it is important to identify the barriers to patient involvement and adherence to high-value care, which include discussions about cost, outcomes, complications of interventions, and the implications that proper care, or a dearth of it, can have on their lives and livelihood.…”