Patient, Family Member, and Public Involvement in Identifying Low-Value Clinical Practices for De-adoption: A Mixed Methods Study of Choosing Wisely Initatives
Date
2020-01-31
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Abstract
Low-value care comprises tests, treatments and procedures where the potential risks outweigh benefits for patients. Despite a growing recognition of the importance to reduce the use of low-value care, ineffective and costly clinical practices continue to be used. While Choosing Wisely and other initiatives have implemented strategies to reduce low-value care, little is known about how to best engage the public in these initiatives. The purpose of this study was to explore the role of patient, family and public members in the development and implementation of Choosing Wisely initiatives that aim to reduce low-value care. A mixed methods study design was used to address the objective through content analysis and qualitative interviews. The content analysis examined two different collections of publicly available online materials (Choosing Wisely clinician lists, i.e., Five Things Physicians and Patients Should Question; and Choosing Wisely patient resources) in order to describe members of the public involvement in Choosing Wisely list creation and development. Content analysis revealed that few members of the public were involved in the development of Choosing Wisely clinician lists. The analysis of patient resource documents suggested that the average Simple Measure of Gobbledygook (SMOG) readability score was a Grade nine level and were categorized at the patient engagement level of Inform where the documents engage the reader by providing only information. Qualitative interviews, conducted to explore future public involvement in reducing low-value care generated five overarching themes: 1) factors influencing understandings of what potentially constitutes low-value care in the clinical interaction; 2) how to communicate about low-value care; 3) perceived barriers to public involvement in the reduction of low-value care (e.g., brief clinical interaction); 4) perceived iii facilitators to public involvement in the reduction of low-value care (e.g., use of educational materials); and 5) suggested strategies to engage the public involvement in Choosing Wisely initiatives. This thesis indicates that there is public involvement in reducing low-value care is feasible and that Choosing Wisely initiatives such as identifying and participating in conversations about low-value care may be an appropriate place for such engagement.
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Keywords
qualitative research, mixed methods, content analysis, low-value care, Choosing Wisely, stakeholder engagement
Citation
de Grood, C. M. (2020). Patient, Family Member, and Public Involvement in Identifying Low-Value Clinical Practices for De-adoption: A Mixed Methods Study of Choosing Wisely Initatives (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.