Dr Belinda Loring is medical advisor for the Choosing Wisely campaign. She discusses the patient resources available to promote campaign messages, and the evidence for their effectiveness.
Choosing Wisely promotes a culture where low value and inappropriate clinical interventions are avoided, and patients and health professionals have well-informed conversations around their treatment options, leading to better decisions and outcomes.
One side to this is building agreement and awareness among health professionals about which interventions offer little value. So far over 25 colleges and specialty societies in New Zealand have developed 129 recommendations about interventions to avoid.
But it takes two to have an informed conversation, and this means empowering health consumers to ask more questions of their health providers.
The Choosing Wisely website has over 45 different patient resources adapted for New Zealand, on specific Choosing Wisely recommendations. These resources discuss the risks and benefits of certain interventions, describe in which situations they might be needed, and when they might do more harm than good. The aim is not to substitute medical advice, but to equip patients to have more informed discussions with their health care provider, and to spread the message that more is not always better.
Surveys of New Zealand doctors in 2016[1] found that patient preference is considered to be a major driver of unnecessary care. However, international evidence suggests that when patients are aware about the harms of unnecessary care, their preferences change.
Clearly there is more to empowering patients and achieving shared-decision making than just producing leaflets, but there is evidence to suggest that simple information resources can play a role in influencing consumer opinion. An evaluation in Canada[2], using very similar resources to Choosing Wisely New Zealand, found that when patients in GP waiting rooms were given educational materials on antibiotics for sinusitis, their knowledge improved significantly; and the majority reported that they would take on board this new information, and discuss it with their health care provider, family, or friends.
Communicating the message that 'more is not always better' can be challenging – but greater awareness amongst health professionals and consumers is needed if we are to reduce the drivers for unnecessary care. Patient resources can be a helpful basis for discussing the risks and benefits of a particular intervention, and jointly deciding with a patient which option is best for their particular situation.
Author: Belinda Loring, Choosing Wisely
References:
- Choosing Wisely “Survey of doctors’ practice regarding unnecessary tests, treatments and procedures in New Zealand” April 2017, http://choosingwisely.org.nz/wp-content/uploads/2018/04/Survey-of-doctors%E2%80%99-practice-regarding-unnecessary-tests-treatments-and-procedures-in-New-Zealand-.pdf
- Silverstein W, Lass E, Born K, et al. A survey of primary care patients’ readiness to engage in the de-adoption practices recommended by Choosing Wisely Canada. BMC Res Notes 2016;9(1):301.