Choosing Wisely

Things Physicians and Patients Should Question

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.

2022 Recommendations

1. Don’t initiate whole breast radiotherapy as a part of breast conservation therapy in women with early stage invasive breast cancer without considering shorter treatment schedules.
2. Don’t initiate management of low-risk prostate cancer without discussing active surveillance.
3. Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.
4. Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry.
5. Due to recently published evidence related to IMRT for breast cancer, ASTRO has withdrawn this recommendation.
6. ​Don’t recommend radiation following hysterectomy for endometrial cancer patients with low-risk disease.
7. Don’t routinely offer radiation therapy for patients who have resected non-small-cell lung cancer (NSCLC) negative margins N0-2 disease.
8. Don’t initiate non-curative radiation therapy without defining the goals of treatment with the patient and considering palliative care referral.
9. Don’t routinely recommend follow-up mammograms more often than annually for women who have had radiotherapy following breast conserving surgery.
10. Don’t routinely add adjuvant whole brain radiation therapy to stereotactic radiosurgery for limited brain metastases.
11. Do not routinely initiate radiation therapy, or other forms of cancer treatment, without consideration of potential financial toxicity to patients.

View the Choosing Wisely list: Ten Things Physicians and Patients Should Question - Released August 2022 - pdf