Table 4 Stakeholder perspectives on how the public should be involved in reducing low-value care
From: Understanding the public’s role in reducing low-value care: a scoping review
Study | Country | Study design | Stakeholder | Setting | Low-value practice(s) | Strategy for public involvement | Supportive of strategy? |
|---|---|---|---|---|---|---|---|
Demand-side stakeholdersa | |||||||
Kullgren [31] 2018 | USA | Focus groups | Patients (seniors) | Not specified | Multiple (potentially harmful medications, cancer screening) | Shared decision-making | Yes; patients felt that understanding risks and benefits and reaching a personalized decision would help them support CW recommendations |
Linsky [32] 2014 | USA | Interviews and focus groups | Patients | Primary care | Unnecessary medications | Shared decision-making | Yes; main theme from focus groups and interviews was the importance of strong patient-provider relationships, trust, and SDM for reducing unnecessary medications |
Hislop [33] 2011 | UK | Interviews | Community members | Government | Low-value care in general | Citizen involvement in disinvestment decision-making | No; community members interviewed felt that taxpayers do not have the knowledge and impartiality required to be involved in decision-making |
Rohrbacher [34] 2008 | Germany | Telephone survey | Patients | Not specified | Low-value care in general | Shared decision-making | Yes; patients want to discuss their preferences and personal experiences with their physician to arrive at the most evidence-based decision |
Schoenborn [35] 2017 | USA | Interviews | Patients (seniors) | Ambulatory clinic | Cancer screening when life expectancy is limited | Shared decision-making | Yes; patients indicated preference for a trusting relationship with their physician and an individualized decision-making process |
Supply-side stakeholdersb | |||||||
Daniels [36] 2018 | UK | Q study and interviews | Physicians and administrators | Government | Low-value care in general | Citizen Involvement in disinvestment decision-making | Yes (cautious); participants held an overall supportive but cautious stance to citizen involvement |
Kanzaria [37] 2015 | USA | Survey | ED physicians | ED | Advanced diagnostic imaging | Educating patients and families on low-probability outcomes and shared decision-making | Ninety-two percent of emergency physicians surveyed and indicated that SDM would be helpful in reducing low-value diagnostic imaging |
Scales [38] 2017 | USA | Survey | Physicians and nurses | Long-term care homes | Unnecessary antibiotics | Educating residents and families about why antibiotics are not necessary | Yes; survey findings supported education as a tool to help reduce unnecessary antibiotic use |
Ellen [39] 2018 | Israel | Interviews | Nurses | Outpatient clinic | Low-value care in general | Educating patients on the dangers of overuse | Yes; interview findings indicate that nurses support the need to educate patients about overuse |
Embrett [40] 2018 | Canada | Focus groups | Physicians | Not specified | Low-value care in general | Engaging patients in a conversation about low-value care in the clinical encounter | Yes; a principal finding from the focus groups was the need for the Choosing Wisely campaign to help facilitate patient conversations about low-value care during the clinical encounter |