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ASH 2015: American Society of Hematology Releases Compilation of Top Choosing Wisely Recommendations Relevant to Hematology

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Key Points

  • This list joins ASH’s 10 recommendations released throughout the past 2 years as part of Choosing Wisely, an initiative that aims to prompt conversations between patients and clinicians about the necessity of certain procedures.
  • As with past ASH lists, harm avoidance was once again established as the campaign’s preeminent guiding principle, with cost, strength of evidence, frequency, relevance, and impact serving as additional factors. 

The American Society of Hematology (ASH) has released a list of five hematology-related tests and procedures to question based on recommendations from other medical societies taking part in the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign. This list joins ASH’s 10 recommendations released throughout the past 2 years as part of Choosing Wisely, an initiative that aims to prompt conversations between patients and clinicians about the necessity of certain procedures. These items will be presented on Monday, December 7, at the 57th ASH Annual Meeting in Orlando, Florida. 

Recognizing the immense benefit of collaboration between medical societies and aiming to avoid duplicating the efforts of other groups, the ASH Choosing Wisely Task Force launched a first-of-its kind review of all existing Choosing Wisely recommendations to identify those published by other professional societies that are highly relevant and important to the practice of hematology. This novel approach aimed to maximize the work of the 70 medical societies that have released their own Choosing Wisely lists and coordinate implementation of their recommendations. 

Recommendations

ASH’s new Choosing Wisely recommendations being promoted to hematologists (available here) include:

  • Don’t image for suspected pulmonary embolism (PE) without moderate or high pretest probability of PE. American College of Radiology
  • Don’t routinely order thrombophilia testing on patients undergoing a routine infertility evaluation. American Society for Reproductive Medicine
  • Don’t perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability. Society for Hospital Medicine, Adult Hospital Medicine
  • Don’t transfuse red blood cells for iron deficiency without hemodynamic instability. American Association of Blood Banks
  • Avoid using positron emission tomography (PET) or PET-computed topography (CT) scanning as part of routine follow-up care to monitor for a cancer recurrence in asymptomatic patients who have finished initial treatment to eliminate the cancer unless there is high-level evidence that such imaging will change the outcome. ASCO

Using a rigorous methodology, the ASH Choosing Wisely Task Force scored 400 recommendations for relevance and importance over a series of iterations, resulting in this list of items deemed to be especially useful to hematologists. As with past ASH lists, harm avoidance was once again established as the campaign’s preeminent guiding principle, with cost, strength of evidence, frequency, relevance, and impact serving as additional factors. 

“The Choosing Wisely initiative is a high-visibility campaign that has increased awareness of overutilization in medicine, and at ASH we believe there is a potential for even greater impact when societies share information and work together to accomplish the same goals,” said ASH Choosing Wisely Task Force Chair Lisa Hicks, MD, Assistant Professor in the Department of Medicine and Staff Physician in the Department of Hematology/Oncology at St. Michael’s Hospital and Assistant Professor in the Department of Medicine at the University of Toronto. “ASH encourages all medical groups to follow its lead by examining other Choosing Wisely lists to find applicable recommendations that will improve quality of care and avoid harm from unnecessary tests and treatments.”

“ASH has shown tremendous leadership by identifying additional Choosing Wisely recommendations relevant to hematologists and creating new ways of disseminating this important information to their members,” said Richard Baron, MD, President and CEO of the ABIM Foundation. “By increasing awareness and understanding of what tests and treatments may be overused or unnecessary across all specialties, we’ll help clinicians be better prepared to join their patients in these critical conversations about their care.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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