The Hospice Clinician Blog

The American Board of Internal Medicine (ABIM) Foundation and a coalition of nine medical societies recently released their recommendations regarding unnecessary tests and treatments that should be reduced to cut costs to the healthcare system. This campaign, called Choosing Wisely®, aims to promote conversations between physicians and patients and help patients choose care that is supported by evidence, not duplicative, free from harm, and truly necessary.

In response to this challenge, national organizations representing medical specialists have been asked to "choose wisely" by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. For example, the American Society of Clinical Oncology made the following 5 recommendations:

1. Don’t use cancer-directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anti-cancer treatment.
2. Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.
3. Don’t perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.
4. Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
5. Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20 percent risk for this complication.

While not one of the initial 9 organizations involved in the campaign, the American Academy of Hospice and Palliative Medicine (AAHPM) announced its partnership with Choosing Wisely® on April 4, 2012, and its list of 5 potentially unnecessary procedures will be unveiled in the fall. Also in the coming months, Consumer Reports will produce additional reports, in English and Spanish, and collaborate with other consumer organizations to distribute them to diverse populations.

The complete list of unnecessary procedures can be viewed online at the Choosing Wisely® website (www.choosingwisely.org).

Posted on April 13, 2012

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