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