title: Critical and honest conversations: the evidence behind the "Choosing Wisely" campaign recommendations by the American Society of Nephrology.
abstract: Estimates suggest that one third of United States health care spending results from overuse or misuse of tests, procedures, and therapies. The American Board of Internal Medicine Foundation, in partnership with Consumer Reports, initiated the "Choosing Wisely" campaign to identify areas in patient care and resource use most open to improvement. Nine subspecialty organizations joined the campaign; each organization identified five tests, procedures, or therapies that are overused, are misused, or could potentially lead to harm or unnecessary health care spending. Each of the American Society of Nephrology's (ASN's) 10 advisory groups submitted recommendations for inclusion. The ASN Quality and Patient Safety Task Force selected five recommendations based on relevance and importance to individuals with kidney disease.Recommendations selected were: (1) Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; (2) do not administer erythropoiesis-stimulating agents to CKD patients with hemoglobin levels ≥10 g/dl without symptoms of anemia; (3) avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD of all causes, including diabetes; (4) do not place peripherally inserted central catheters in stage 3-5 CKD patients without consulting nephrology; (5) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.These five recommendations and supporting evidence give providers information to facilitate prudent care decisions and empower patients to actively participate in critical, honest conversations about their care, potentially reducing unnecessary health care spending and preventing harm.
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. williams.amy@mayo.edu
authors.forename: Amy W
authors.initials: AW
authors.lastname: Williams
authors.forename: Amy C
authors.initials: AC
authors.lastname: Dwyer
authors.forename: Allison A
authors.initials: AA
authors.lastname: Eddy
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Linas
authors.forename: Beckie
authors.initials: B
authors.lastname: Michael
authors.forename: Ann M
authors.initials: AM
authors.lastname: O'Hare
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Schaefer
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Shaffer
authors.forename: Howard
authors.initials: H
authors.lastname: Trachtman
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: And Ronald J
authors.initials: AR
authors.lastname: Falk
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002405:Catheterization, Central Venous; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics / Q000592:standards; D019983:Guideline Adherence; D017048:Health Care Costs; D006293:Health Promotion; D006300:Health Services Misuse / Q000191:economics / Q000517:prevention & control*; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009398:Nephrology / Q000191:economics / Q000592:standards; D061214:Patient Safety; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011368:Professional-Family Relations; D016730:Program Development; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D012955:Societies, Medical; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006397:Hematinics