Patient Care and Research

Choosing Wisely

Things Physicians and Patients Should Question

choosing wisely

The Choosing Wisely campaign, developed by the American Board of Internal Medicine (ABIM) Foundation, aims to promote conversations between providers and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary. Specialty societies are encouraged to develop lists of Five Things Physicians and Patients Should Question that are comprised of evidence-based recommendations that highlight potentially unnecessary tests or therapies and promote informed and collaborative discussions between physicians and patients.

ASTRO released its initial list of five radiation oncology-specific treatments that are commonly ordered but may not always be appropriate during ASTRO's 55th Annual Meeting in Atlanta. A second list of five interventions was released at the 56th Annual Meeting in San Francisco.

View the second Choosing Wisely list - Released September 2014 
View the first Choosing Wisely list - Released September 2013
Read the article in Practical Radiation Oncology on ASTRO's 2013 Choosing Wisely list

How the list was developed 

2013 List 

ASTRO’s Choosing Wisely list was developed after several months of careful consideration and thorough review, using the most current evidence about management and treatment options. A survey was sent to ASTRO’s Health Policy Council, Health Policy Committee, Clinical Affairs and Quality Committee, the Guidelines Subcommittee, Best Practices Subcommittee, Measures Subcommittee and disease-site resource panels in order to identify potential items for inclusion in the list. A seven-member work group was formed, with representation from ASTRO’s Clinical Affairs and Quality, Health Policy and Government Relations councils, and each work group member chose their top eight items from the total of 34 topics that had been suggested in the initial survey. The results were tabulated and a list of the highest scoring items created a short list of 13 draft items. 

Three conference calls were subsequently held to further refine the list and finalize the wording of the items based on input from ASTRO’s Board of Directors. An extensive literature review was conducted for each topic, and the work groups drafted the text and selected references for each topic. The final items for submission were approved by ASTRO’s Board of Directors.

2014 List 

In January 2014, the American Society for Radiation Oncology (ASTRO) formed a workgroup to develop its second Choosing Wisely list, which included representatives from health policy, government relations, and clinical affairs and quality. The work group began by narrowing a list of 28 draft concepts to nine potential Choosing Wisely items. Next, an electronic anonymous survey was sent to the ASTRO membership to rate the value and relevancy of each of the items. The survey also included an open text box for members to comment on the suggested items and to provide additional ideas for Choosing Wisely items. Based on the survey results, the work group submitted a shortlist of eight items to the ASTRO Board of Directors, from which the Board chose five items to move forward.

Literature reviews were conducted for the five Choosing Wisely items selected by the Board and the workgroup drafted verbiage, bullet points and references for each item. Following a second review by the Board of Directors, one of the items was replaced with an alternate item from the shortlist. The final list received approval from the Board and was then submitted to the American Board of Internal Medicine Foundation.