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Critical and Honest Conversations: The Evidence Behind the “Choosing Wisely” Campaign Recommendations by the American Society of Nephrology

Amy W. Williams, Amy C. Dwyer, Allison A. Eddy, Jeffrey C. Fink, Bertrand L. Jaber, Stuart L. Linas, Beckie Michael, Ann M. O’Hare, Heidi M. Schaefer, Rachel N. Shaffer, Howard Trachtman, Daniel E. Weiner and and Ronald J. Falk
CJASN October 2012, 7 (10) 1664-1672; DOI: https://doi.org/10.2215/CJN.04970512
Amy W. Williams
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Amy C. Dwyer
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Allison A. Eddy
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Jeffrey C. Fink
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Bertrand L. Jaber
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Stuart L. Linas
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Beckie Michael
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Ann M. O’Hare
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Heidi M. Schaefer
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Rachel N. Shaffer
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Howard Trachtman
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Daniel E. Weiner
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and Ronald J. Falk
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Summary

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.

  • Copyright © 2012 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 7 (10)
Clinical Journal of the American Society of Nephrology
Vol. 7, Issue 10
October 05, 2012
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Critical and Honest Conversations: The Evidence Behind the “Choosing Wisely” Campaign Recommendations by the American Society of Nephrology
Amy W. Williams, Amy C. Dwyer, Allison A. Eddy, Jeffrey C. Fink, Bertrand L. Jaber, Stuart L. Linas, Beckie Michael, Ann M. O’Hare, Heidi M. Schaefer, Rachel N. Shaffer, Howard Trachtman, Daniel E. Weiner, and Ronald J. Falk
CJASN Oct 2012, 7 (10) 1664-1672; DOI: 10.2215/CJN.04970512

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Critical and Honest Conversations: The Evidence Behind the “Choosing Wisely” Campaign Recommendations by the American Society of Nephrology
Amy W. Williams, Amy C. Dwyer, Allison A. Eddy, Jeffrey C. Fink, Bertrand L. Jaber, Stuart L. Linas, Beckie Michael, Ann M. O’Hare, Heidi M. Schaefer, Rachel N. Shaffer, Howard Trachtman, Daniel E. Weiner, and Ronald J. Falk
CJASN Oct 2012, 7 (10) 1664-1672; DOI: 10.2215/CJN.04970512
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  • Article
    • Summary
    • Introduction
    • Method for Identifying the Five “Choosing Wisely” Recommendations
    • Recommendations
    • Other Selected Recommendations under Consideration
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More in this TOC Section

  • Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases
  • Alport Syndrome in Women and Girls
  • Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health
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  • Serious Illness Treatment Preferences for Older Adults with Advanced CKD
  • Prediction of Risk of Death for Patients Starting Dialysis: A Systematic Review and Meta-Analysis
  • One-Time Fecal Immunochemical Screening for Advanced Colorectal Neoplasia in Patients with CKD (DETECT Study)
  • Health Outcome Priorities of Older Adults with Advanced CKD and Concordance with Their Nephrology Providers Perceptions
  • Medication Safety Principles and Practice in CKD
  • Building an Ideal Quality Metric for ESRD Health Care Delivery
  • Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?
  • Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis
  • Time to Improve Informed Consent for Dialysis: An International Perspective
  • Serious Illness Conversations in ESRD
  • Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study
  • Patterns and Predictors of Screening for Breast and Cervical Cancer in Women with CKD
  • Screening Women with CKD for the Emperor of All Maladies
  • Practice Change Is Needed for Dialysis Decision Making with Older Adults with Advanced Kidney Disease
  • Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease
  • Peripherally Inserted Central Catheters and Hemodialysis Outcomes
  • Nephrologists Versus Peripherally Inserted Central Catheters: Are the PICCs Winning?
  • The Evolving Ethics of Dialysis in the United States: A Principlist Bioethics Approach
  • The Role of Time-Limited Trials in Dialysis Decision Making in Critically Ill Patients
  • The Ethics of Chronic Dialysis for the Older Patient: Time to Reevaluate the Norms
  • How the ESRD Quality Incentive Program Could Potentially Improve Quality of Life for Patients on Dialysis
  • The Value of Personalizing Medicine: Medical Oncologists' Views on Gene Expression Profiling in Breast Cancer Treatment
  • Advance Care Planning for Patients with Advanced CKD: A Need to Move Forward
  • Patient-Centered Care: An Opportunity to Accomplish the "Three Aims" of the National Quality Strategy in the Medicare ESRD Program
  • Training the Next Generation's Nephrology Workforce
  • Early Dialysis Initiation, a Look from the Rearview Mirror to What's Ahead
  • Healthcare Intensity at Initiation of Chronic Dialysis among Older Adults
  • Five Policies to Promote Palliative Care for Patients with ESRD
  • Has the Yearly Increase in the Renal Replacement Therapy Population Ended?
  • Considerations in Starting a Patient with Advanced Frailty on Dialysis: Complex Biology Meets Challenging Ethics
  • AKI Transition of Care: A Potential Opportunity to Detect and Prevent CKD
  • Initiation of Dialysis at Higher Levels of Estimated GFR and Subsequent Withdrawal
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