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An Update on Choosing Wisely

Posted 8/25/2015

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  Many of you are familiar with the Choosing Wisely initiative that was started by the American Board of Internal Medicine in 2012. It is an attempt to focus attention, in all medical specialties, on the choices and recommendations that are made in a patient's care. Yes, it is partly about saving money, but it is mostly about value for care--about not subjecting someone to a procedure or treatment that is not going to be helpful and may even be harmful.

  Clearly this is emotionally loaded territory. We are absolutely not talking about the infamous Death Panels, but we are talking about careful consideration, in partnership of physician and patient and maybe family, of treatment possibilities. As I said, this initiative spans all medical specialty areas, but I am only informed about oncology. In our world, there are increasing numbers of new and hugely expensive drugs that may truly offer very little to an ill patient. There must be honest conversation about the risks, the potential benefits, and the cost (emotional, physical, and financial). There should also be more conversation about some tests that are too routinely ordered and really contribute nothing to overall understanding or goals of care.

  This is an article from Medscape with the oncology update. I give you the start and a link. I will follow it with a link to ASCO's document about this program.

Has the Choosing Wisely Campaign Affected Clinical Oncology
Victoria Stern, MA

The aim of the Choosing Wisely initiative, launched in 2012 by the ABIM Foundation, is to encourage providers and patients to follow evidence-based treatment regimens and to cease performing tests and procedures that probably provide no benefit and contribute to healthcare spending in the United States.
Although most oncologists agree about the importance of the Choosing Wisely campaign, it is unclear whether they are actually incorporating the 10 Choosing Wisely recommendations issued by the American Society of Clinical Oncology (ASCO), into practice.
Dean Gesme, MD, an oncologist at the Minneapolis Clinic, part of the US Oncology Network, has observed the Choosing Wisely recommendations begin to drive patient care in his group of 60 oncologists. "The recommendations help us provide valuable care and subtract out-of-date practices that do not contribute to a patient's physical, mental, and financial health," said Dr Gesme. "We distribute Choosing Wisely guidelines to physicians in our group as well as work with health systems and the media to publicize and highlight evidence-based oncology care. Although Choosing Wisely recommendations are not enforced throughout the US Oncology Network, they are widely publicized and encouraged."
Dr Gesme acknowledges that in his group, there are several areas that still need work, such as scaling back on antinausea drugs in situations when they're not called for or using a cheaper drug in lieu of a more expensive product, but overall, "the Choosing Wisely recommendations have been very effective in our practice."

Read more:

And from ASCO: 

Five Things Physicians and Patients Should Question

The American Society of Clinical Oncology (ASCO) is a medical professional oncology society committed to conquering cancer through research, education, prevention and
delivery of high-quality patient care. ASCO recognizes the importance of evidence-based cancer care and making wise choices in the diagnosis and management of patients
with cancer. After careful consideration by experienced oncologists, ASCO highlights ten categories of tests, procedures and/or treatments whose common use and clinical
value are not supported by available evidence. These test and treatment options should not be administered unless the physician and patient have carefully considered if their
use is appropriate in the individual case. As an example, when a patient is enrolled in a clinical trial, these tests, treatments and procedures may be part of the trial protocol and
therefore deemed necessary for the patient’s participation in the trial.
These items are provided solely for informational purposes and are not intended to replace a medical professional’s independent judgment or as a substitute for consultation with
a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider. New evidence may
emerge following the development of these items. ASCO is not responsible for any injury or damage arising out of or related to any use of these items or to any errors or omissions.


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