Evidence map›Paper›PMID 32124126›Full record

ArticleAnnals of surgical oncology2020

Barriers and Facilitators to De-Implementation of the Choosing Wisely

Margaret E Smith, C Ann Vitous, Tasha M Hughes, Sarah P Shubeck, Reshma Jagsi, Lesly A Dossett

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 1 pooled it
13.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 1 synthesis or guideline pooled it, 72 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Margaret E SmithDepartment of Surgery, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
C Ann VitousCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Tasha M HughesDepartment of Surgery, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Sarah P ShubeckDepartment of Surgery, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Reshma JagsiDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Lesly A DossettDepartment of Surgery, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. ldossett@umich.edu.
University of Michigan–Ann Arbor · US

Funding

Error Identification Between Health Systems—A Patient Safety Blind SpotK08HS026030 · AHRQ · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI DOSSETT, LESLY A · 2018 to 2021
$604k
Agency for Healthcare Research and Quality K08 HS026030-02AHRQ HHS K08 HS026030
6 · The paper itself

Abstract

backgroundTo address overuse of unnecessary practices, several surgical organizations have participated in the Choosing Wisely

methodsWe sampled surgeons who treat breast cancer in a variety of practice types and geographic regions in the United States. Using a semi-structured guide, we conducted telephone interviews (n = 18) to elicit attitudes and understand practices relating to the four identified breast cancer procedures in the Choosing Wisely

resultsFor the two procedures successfully de-implemented, surgeons described a high level of confidence in the data supporting the recommendations. In contrast, surgeons frequently described a lack of familiarity or skepticism toward the recommendation to avoid sentinel-node biopsy in women ≥ 70 years of age and the influence of other collaborating oncology providers as justification for continued use. Regarding contralateral prophylactic mastectomy, surgeons consistently agreed with the recommendation that this was unnecessary, yet reported continued utilization due to the value placed on patient autonomy and preference.

conclusionsWith a growing focus on the elimination of ineffective, unproven or low value practices, it is imperative that the behavioral determinants are understood and targeted with specific interventions to decrease utilization rapidly.

Indexed as

Breast NeoplasmsUnnecessary ProceduresFemaleHumansMastectomyPractice Guidelines as TopicUnited States

Identifiers

PMID32124126
PMCPMC7338259
OpenAlexW3009903109

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.