Skip to main content
SpringerLink
Log in

The Canadian Choosing Wisely campaign: the Canadian Hematology Society’s top five tests and treatments

  • Review Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Choosing Wisely Canada (CWC), a medical stewardship campaign, encourages dialogue between physicians and patients to promote high-quality decision-making. Medical societies develop lists of tests, treatments, and procedures that are unnecessary, reduce value, and may cause harm. The Canadian Hematology Society (CHS) elicited suggestions for CWC recommendations from its members and received 35 unique suggestions. A working group rated these based on their potential for harm, benefit, frequency of use and value. Twelve highly ranked items were subjected to systematic evidence review. The final items were included in the list if they were of sufficient evidence base and met pre-defined core principles. The CHS-CWC recommendations are: to avoid IVIG treatment for asymptomatic immune thrombocytopenia, not bridge warfarin in low-risk patients going for procedures, not perform thrombophilia testing in the workup of early pregnancy loss, avoid fine-needle aspiration in lymphoma diagnosis, and not transfuse red blood cells for an arbitrary hemoglobin threshold. Through implementation of these recommendations, physicians will reduce potential harm to patients and increase the value of health care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. What is CWC? (2014) Choosing Wisely Canada. http://www.choosingwiselycanada.org/about/what-is-cwc/. Accessed Sept 30 2014

  2. Cassel CK, Guest JA (2012) Choosing Wisely: helping physicians and patients make smart decisions about their care. JAMA 307(17):1801–1802

    Article  CAS  PubMed  Google Scholar 

  3. Choosing Wisely: about Choosing Wisely (2014) American Board of Internal Medicine. http://www.choosingwisely.org/about-us/

  4. Grady D, Redberg RF (2010) Less is more: how less health care can result in better health. Arch Intern Med 170(9):749–750. doi:10.1001/archinternmed.2010.90

    Article  PubMed  Google Scholar 

  5. Brody H (2010) Medicine’s ethical responsibility for health care reform—the top five list. N Engl J Med 362(4):283–285. doi:10.1056/NEJMp0911423

    Article  CAS  PubMed  Google Scholar 

  6. Choosing Wisely: an initiative of the ABIM Foundation. (2014) American Board of Internal Medicine. http://www.choosingwisely.org. Accessed Sept. 30 2014

  7. Hicks LK, Bering H, Carson KR, Kleinerman J, Kukreti V, Ma A, Mueller BU, O’Brien SH, Pasquini M, Sarode R, Solberg L, Haynes AE, Crowther MA (2013) The ASH Choosing Wisely® campaign: five hematologic tests and treatments to question. Blood 122(24):3879–3883. doi:10.1182/blood-2013-07-518423

    Article  CAS  PubMed  Google Scholar 

  8. McMartin K Intravenous immune globulin for primary immune thrombocytopenia: a rapid review. Toronto: Health Quality Ontario. http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/rapid-reviews. Accessed 2014 August 15

  9. Pierce LR, Jain N (2003) Risks associated with the use of intravenous immunoglobulin. Transfus Med Rev 17(4):241–251

    Article  PubMed  Google Scholar 

  10. Duhem C, Dicato M, Ries F (1994) Side-effects of intravenous immune globulins. Clin Exp Immunol 97(Suppl 1):79

    PubMed Central  PubMed  Google Scholar 

  11. Bradley LA, Palomaki GE, Bienstock J, Varga E, Scott JA (2012) Can Factor V Leiden and prothrombin G20210A testing in women with recurrent pregnancy loss result in improved pregnancy outcomes?: Results from a targeted evidence-based review. Genet Med 14 (1):39–50. http://www.nature.com/gim/journal/v14/n1/suppinfo/gim0b013e31822e575bs1.html

  12. Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Crowther MA (2011) The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 117(16):4190–4207

    Article  CAS  PubMed  Google Scholar 

  13. Sehatzadeh S (2014) Heparin bridging therapy during warfarin interruption for surgical and invasive interventional procedures: a rapid review of primary studies. Toronto: Health Quality Ontario. http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/rapid-reviews. Accessed 2014 August 21

  14. Siegal D, Yudin J, Kaatz S, Douketis J, Lim W, Spyropoulos A (2012) Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation 126(13):1630

    Article  CAS  PubMed  Google Scholar 

  15. Bates S, Greer I, Middeldorp S, Veenstra D, Prabulos A, Vandvik P (2012) VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e691S–e736S

    PubMed Central  CAS  PubMed  Google Scholar 

  16. Chan W, Rey E, Kent N, Chan W, Kent N, Rey E, Corbett T, David M, Douglas M, Gibson P (2014) Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can JOGC J d’obstetrique et gynecologie du Can JOGC 36(6):527

    Google Scholar 

  17. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, Lister TA (2014) Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 32(27):3059–3067

    Article  PubMed  Google Scholar 

  18. Soong C, Wong, B. Canadian society of internal medicine. Five things physicians and patients should question. Choosing Wisely Canada. http://www.choosingwiselycanada.org/recommendations/canadian-society-of-internal-medicine-2/. Accessed 26 Aug 2014

  19. Callum JL, Waters JH, Shaz BH, Sloan SR, Murphy MF (2014) The AABB recommendations for the Choosing Wisely campaign of the American Board of Internal Medicine. Transfusion 54(9):2344–2352. doi:10.1111/trf.12802

    Article  PubMed  Google Scholar 

  20. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B (2010) International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 115(2):168–186

    Article  CAS  PubMed  Google Scholar 

  21. Neunert CE (2013) Current management of immune thrombocytopenia. ASH Educ Program Book 2013(1):276–282. doi:10.1182/asheducation-2013.1.276

    Google Scholar 

  22. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest J 141(2_suppl):e326S–e350S

    Article  CAS  Google Scholar 

  23. Spyropoulos AC, Douketis JD (2012) How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood 120(15):2954–2962

    Article  CAS  PubMed  Google Scholar 

  24. Swerdlow SH (2008) WHO classification of tumours of haematopoietic and lymphoid tissues, vol 2. World Health Organization

  25. Costa V (2014) The diagnostic accuracy of fine-needle aspiration cytology in the diagnosis of lymphoma: a rapid review. http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations. Accessed 21 July 2014

  26. Hehn ST, Grogan TM, Miller TP (2004) Utility of fine-needle aspiration as a diagnostic technique in lymphoma. J Clin Oncol 22(15):3046–3052. doi:10.1200/jco.2004.02.104

    Article  PubMed  Google Scholar 

  27. Demharter J, Müller P, Wagner T, Schlimok G, Haude K, Bohndorf K (2001) Percutaneous core-needle biopsy of enlarged lymph nodes in the diagnosis and subclassification of malignant lymphomas. Eur Radiol 11(2):276–283

    Article  CAS  PubMed  Google Scholar 

  28. Bulger J, Nickel W, Messler J, Goldstein J, O’Callaghan J, Auron M, Gulati M (2013) Choosing wisely in adult hospital medicine: five opportunities for improved healthcare value. J Hosp Med 8(9):486–492. doi:10.1002/jhm.2063

    Article  PubMed  Google Scholar 

  29. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E, Transfusion Requirements in Critical Care Investigators. Canadian Critical Care Trials Group (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340(6):409–417. doi:10.1056/nejm199902113400601

    Article  CAS  PubMed  Google Scholar 

  30. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, Holcomb JB, Illoh O, Kaplan LJ, Katz LM, Rao SV, Roback JD, Shander A, Tobian AAR, Weinstein R, Swinton McLaughlin LG, Djulbegovic B, Aabb ftCTMCot (2012) Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Int Med 157(1):49–58. doi:10.7326/0003-4819-157-1-201206190-00429

  31. Salpeter SR, Buckley JS, Chatterjee S (2014) Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review. Am J Med 127(2):124–131.e123. doi:10.1016/j.amjmed.2013.09.017

  32. Callum J, Lin Y, Pinkerton P, Karkouti K, Pendergrast J, Robitaille N, Tinmouth A, Webert K (2011) Bloody easy 3, blood transfusions, blood alternatives and transfusion reactions, a guide to transfusion medicine. 3rd. Toronto (ON): Sunnybrook and Women’s College Health Sciences Centre

  33. Morden NE, Colla CH, Sequist TD, Rosenthal MB (2014) Choosing wisely—the politics and economics of labeling low-value services. N Engl J Med 370(7):589–592

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Good Stewardship Working G (2011) The “top 5” lists in primary care: meeting the responsibility of professionalism. Arch Intern Med 171(15):1385–1390. doi:10.1001/archinternmed.2011.231

    Article  Google Scholar 

  35. Langer-Gould AM, Anderson WE, Armstrong MJ, Cohen AB, Eccher MA, Iverson DJ, Potrebic SB, Becker A, Larson R, Gedan A (2013) The American Academy of Neurology’s top five choosing wisely recommendations. Neurology 81(11):1004–1011

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank members of the working group (Drs. Vighnesh Bharath, Anthony Chan, Lynn Savoie, Deborah Siegal, and Jeffrey Weitz) for their contributions and the HQO and CADTH for their support with the evidence reviews. Dr. Wendy Levinson provided leadership to the entire CWC campaign. CMH is supported by a fellowship provided by the Department of Oncology, McMaster University. No direct funding has been received for this work. This paper has not been previously presented.

Author contributions

CMH, MAC, ADS, and SC contributed to the study design and implementation. CMH chaired the working group and wrote the manuscript. All authors contributed to review and revisions of the manuscript. All authors provided approval of the final version.

Conflicts of interest

MAC discloses having sat on advisory boards for Bayer, Boehringer-Ingelheim, Pfizer, Leo Pharma, Portola, and AKP America. MAC holds a Career Investigator Award from the Heart and Stroke Foundation of Ontario and the Leo Pharma Chair in Thromboembolism Research at McMaster University. MAC’s institution has received funding for research projects from Leo Pharma and Bayer. MAC has received funding for presentations from BMS-Pfizer alliance, Leo Pharma, Bayer, Celgene, Shire, and CSL Behring. The remaining authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, McMaster University, Hamilton, Canada

    Christopher M. Hillis & Mark A. Crowther

  2. Department of Oncology, McMaster University, Hamilton, Canada

    Christopher M. Hillis

  3. Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Aaron D. Schimmer

  4. Division of Hematology, Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Canada

    Stephen Couban

  5. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada

    Mark A. Crowther

  6. Juravinski Cancer Centre, Rm 3-87, 699 Concession St., Hamilton, ON, L8V 5C2, Canada

    Christopher M. Hillis

Authors
  1. Christopher M. Hillis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron D. Schimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen Couban
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark A. Crowther
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher M. Hillis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hillis, C.M., Schimmer, A.D., Couban, S. et al. The Canadian Choosing Wisely campaign: the Canadian Hematology Society’s top five tests and treatments. Ann Hematol 94, 541–545 (2015). https://doi.org/10.1007/s00277-015-2304-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-015-2304-4

Keywords

Search

Navigation