The Hematologist

May-June 2014, Volume 11, Issue 3

Update on the 2013 ASH Choosing Wisely Initiative

Lisa K. Hicks, MD, MSc Staff Hematologist, St. Michael’s Hospital
Assistant Professor, University of Toronto

Published on: April 10, 2014

Choosing Wisely is an initiative led by the ABIM Foundation in partnership with professional societies across the country. This medical stewardship campaign aims to encourage physicians and patients to question the necessity of common medical tests and treatments. ASH released its first Choosing Wisely list at the ASH annual meeting in December 2013. In brief, the ASH Choosing Wisely campaign suggests the following: 1) use the minimum number of red blood cell transfusion units to treat symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dl in stable, non-cardiac inpatients); 2) do not perform thrombophilia testing in patients with a provoked venous thromboembolic event (VTE); 3) do not use inferior vena cava (IVC) filters in the routine management of patients with a VTE; 4) do not use plasma to reverse the activity of vitamin K antagonists in non-emergency situations; and 5) limit CT surveillance for aggressive lymphoma in asymptomatic patients in complete remission.

After the release of the ASH Choosing Wisely List, the ASH Choosing Wisely Task Force was inundated with feedback from ASH members. The vast majority of feedback was positive and two major themes emerged. First, many members told us they want tools that will aid them in sharing the ASH Choosing Wisely message with their home institutions through teaching and continuing education sessions. In an effort to meet this request, ASH has developed a public-access Choosing Wisely slide deck. The slide deck summarizes the list, identifies the underlying evidence, and describes the methodology used to generate each of the ASH Choosing Wisely recommendations. We encourage all members to use it, and pass it on. ASH is also developing a Choosing Wisely pocket guide that will be available on the same Web page.

In addition to requests for tools to help disseminate the Choosing Wisely message, the Task Force received numerous emails suggesting that ASH produce a second Choosing Wisely list. In collaboration with the ABIM Foundation, ASH has already started working on a second list. Similar to the first ASH list, the second will be evidence-based and will prioritize tests and treatments that have limited benefit but a recognized risk of harm; the Task Force is aiming to release the second list at the annual meeting in December.

The Choosing Wisely Campaign has a formal partnership with Consumer Reports and other consumer groups to both facilitate outreach to patients and direct dissemination to consumers. ASH has been working with Consumer Reports to produce an article geared toward patients, focusing on ASH’s recommendation to avoid routine use of IVC filters. We anticipate that this resource will be available in mid 2014. It will be posted on both the ASH Choosing Wisely landing page, and at www.consumerreports.org.

The future challenges for the ASH Choosing Wisely Task Force are effective implementation and measurement of outcomes of the recommendations. How can we encourage the implementation of Choosing Wisely recommendations, and how can we determine if Choosing Wisely recommendations are leading to beneficial changes in patient care? These two related objectives are likely to be the most exacting aspects of this project. As yet, we on the ASH Choosing Wisely Task Force don’t have the answers to these questions, but we look forward to updating ASH membership as we tackle these issues.

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