Few Choosing Wisely Initiative quality measures address issues pertaining to cancer and other serious chronic illness.
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The majority of Choosing Wisely recommendations focus on diagnostic and procedural concerns, with few designed to address treatment, prevention, or palliative care.
The American Board of Internal Medicine initiated the Choosing Wisely Initiative in 2012 to identify and curb unnecessary and wasteful medical expenditures. Since its introduction, 461 Choosing Wisely measures have been designed through a collaboration with 75 health care organizations.
Arif H Kamal, MD, MHS, MBA, assistant professor of medicine and assistant professor of business administration at Duke University School of Medicine (Durham, NC), and colleagues sought to determine the prevalence cancer-related Choosing Wisely recommendations as compared with noncancer recommendations. They also wanted to determine whether recommendations reflected the reality of contemporary cancer care, in which many cancers have become long-term, chronic illnesses.
Researchers reviewed all published Choosing Wisely recommendations issued between April 2002 and May 2016. They observed that cancer-related recommendations accounted for 15% (n = 71) of overall recommendations, of which 14% (n = 10) were developed by ASCO. Other chronic illness—such as diabetes, heart disease, Alzheimer disease, asthma, stroke, and chronic obstructive pulmonary disease—further accounted for 15% of recommendations (n = 68). The majority of recommendations (70%; n = 322) addressed “other” disease states.
Prostate (28%) and breast cancer (23%) accounted for the majority of cancer-related recommendations. Seventy-nine percent of cancer guidelines (n = 66) addressed issues pertaining to diagnostic procedures, imaging, tests, or medical procedures. Twelve percent (n = 10) addressed treatment issues, with medication use and cancer prevention accounting for 5% of recommendations each.
Choosing Wisely recommendations regarding other chronic illnesses followed a similar pattern, with 72% (n = 60) of recommendations concerning imaging, tests, and procedures. Treatment-related recommendations accounted for 13% (n = 11) of guidelines, with medication use accounting for 8% (n = 7) and prevention accounting for 6% (n = 5).
“Quality measures involving serious illness, including cancer, represent a minority of Choosing Wisely measures,” said Dr Kamal. “Future measures should target the chronic illness aspects of cancer care, including prevention, survivorship, and palliative care.”
