New approaches needed to advance Choosing Wisely

Canadian researchers say new approaches are needed to advance the aims of Choosing Wisely and reduce overuse in practice.

Evidence indicates that making lists of recommendations and stimulating awareness are insufficient by themselves to drive practice change. Influencing the established practice of doctors requires much more than a voluntary effort of specialty societies. Complex cultural, systems and structural barriers prevent recommendations being put into practice.

The authors say overuse is a multifactorial problem, at the intersection of clinician habits, behaviours, and training, and compounded by public and patient expectations and demands. A considered and evidence-based approach is therefore needed with robust implementation strategies sensitive to the complexities of different practice environments.

The authors cover a number of recommendations about reducing overuse and advancing Choosing Wisely. These include: educating and engaging the public; de-implementation research priorities; changing practice; and supporting doctors to reduce overuse.

They say partnerships with other clinicians such as nurses, dentists, and pharmacists are needed to develop and implement recommendations. For example, a medical directive at a Canadian hospital to empower nurses to remove unnecessary urinary catheters on an inpatient medical unit led to a sustained decrease in catheter use per patient day and reduced catheter associated urinary tract infections.


The reference is Born K, Kool T, Levinson W. Reducing overuse in healthcare: advancing Choosing Wisely. BMJ 2019;367:l6317 doi: 10.1136/bmj.l6317. Published 5 November 2019.