A look back at Choosing Wisely: Doctors say it's valuable, but awareness remains a problem

Doctor patient
Clinicians see the value in Choosing Wisely, but many aren't aware of it, according to new research.

Providers who participate in the Choosing Wisely campaign see value in it, but a new study finds that there hasn't been much growth in awareness of the program over the last few years.

The ABIM Foundation and Consumer Reports launched the Choosing Wisely program in 2012 to encourage physicians to have conversations with patients on potentially wasteful or unneeded treatments and procedures. The foundation issued surveys to a nationally representative sample of 600 doctors in 2014 and 2017 to assess how many physicians were using the program and their feelings on its effectiveness, according to a study published in Health Affairs. 

The study found that in that three-year window the number of surveyed doctors who were aware of Choosing Wisely increased slightly from 21% to 25%. However, of those who were aware of the campaign, more than 90% said it was useful in both 2014 and 2017. 

The survey found that some physicians find it hard to have these crucial conversations with patients. Forty-two percent said such conversations had become harder in 2014, and 46% said the same in 2017. Doctors cited a number of concerns in adopting Choosing Wisely's recommendations, including worries about malpractice suits and patient demands. 

Despite the perception that the conversations may be becoming harder, the overwhelming majority of respondents said they were either very comfortable or somewhat comfortable discussing low-value care with patients. 

RELATED: Doctors continue to provide unnecessary tests and procedures, study finds 

The need to get the word out about programs like Choosing Wisely can be a significant barrier to reducing the amount of unneeded treatments and tests patients undergo, the researchers said. 

"Challenges to reducing the use of low-value care are substantial and are compounded by difficulties in disseminating innovations in health care," they said. 

Providers should deploy interventions that education clinical staff on guidelines and include frequent follow-ups and feedback, they concluded. 

RELATED: Study provides physician perspective on overtreatment 

In an accompanying commentary, a trio of VA Ann Arbor Healthcare System researchers said that the Choosing Wisely campaign has accomplished much in its first five years, but there is still work that can be done to ensure that the program continues to find success for five more.

 A key challenge, the authors said, is that the program will need to identify which of its clinical recommendations are high-priority items. This will require input from providers across different specialties and perspectives, as patients are rarely treated by clinicians in just one specialty. 

RELATED: Hospital-based primary care clinics more likely to order unnecessary tests and services

The commentary also reinforces the study's conclusion that additional education and outreach is needed to get doctors involved and using the guidelines. 

"A convergence of activities and incentives for realizing the potential of Choosing Wisely in the next five years already exists," the authors said. "It is now time to take those steps."