Abstract
BackgroundLow-value care initiatives are rapidly growing; however, it is not clear how members of the public should be involved. The objective of this scoping review was to systematically examine the literature describing public involvement in initatives to reduce low-value care.MethodsEvidence sources included MEDLINE, EMBASE, and CINAHL databases from inception to November 26, 2019, grey literature (CADTH Tool), reference lists of included articles, and expert consultation. Citations were screened in duplicate and included if they referred to the public’s perception and/or involvement in reducing low-value care. Public included patients or citizens without any advanced healthcare knowledge. Low-value care included medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost-effective. Extracted data pertained to study characteristics, low-value practice, clinical setting, and level of public involvement (i.e., patient-clinician interaction, research, or policy-making).ResultsThe 218 included citations were predominantly original research (n = 138, 63%), published since 2010 (n = 192, 88%), originating from North America (n = 146, 67%). Most citations focused on patient engagement within the patient-clinician interaction (n = 156, 72%), using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Fewer citations examined public involvement in low-value care policy-making (n = 33, 15%). Among citations that examined perspectives regarding public involvement in initiatives to reduce low-value care (n = 10, 5%), there was consistent support for the utility of tools applied within the patient-clinician interaction and less consistent support for involvement in policy-making.ConclusionsEfforts examining public involvement in low-value care concentrate within the patient-clinician interaction, wherein patient-oriented educational materials and shared decision-making tools have been commonly studied and are associated with reductions in low-value care. This contrasts with inclusion of the public in low-value care policy decisions wherein tools to promote engagement are less well-developed and involvement not consistently viewed as valuable.Trial registrationOpen Science Framework (https://osf.io/6fsxm)
Highlights
Low-value care initiatives are rapidly growing; it is not clear how members of the public should be involved
Our study identified that efforts examining public involvement in low-value care concentrate within the patient-clinician interaction, wherein patient-oriented educational materials and shared decision-making tools have been commonly studied and are associated with reductions in low-value care
Our operational definition for “low-value care” was based on that proposed by Elshaug et al as a medical test or treatment “in which evidence suggests it confers no or very little benefit for patients, or risk of harm exceeds probable benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefit” [1]
Summary
Low-value care initiatives are rapidly growing; it is not clear how members of the public should be involved. The ongoing use of low-value healthcare practices (i.e., low-value care), broadly defined as medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost effective [1], impedes the delivery of safe, efficient, and cost-effective healthcare [2]. In the UK, the National Institute for Health and Care Excellence (NICE) has included upwards of 1000 “Do Not Do” recommendations in their evidence-based guidelines for care in the National Health Service (NHS) [9]. This identification of low-value practices has not been followed by a commensurate reduction in their use [10,11,12]. This is likely influenced by a number of factors [13], one of which may be challenges with engaging relevant stakeholders such as clinicians, decision makers, and the public
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
