Choosing Wisely: Five Commonly Performed Tests and Treatments in Pulmonary Medicine That May Not Always Be Necessary
As part of the ABIM Foundation’s Choosing Wisely® campaign, a collaborative taskforce assembled by the American Thoracic Society and the American College of Chest Physicians has released a list of five commonly performed pulmonary medicine tests and treatments that may not always be necessary. The list is designed to help promote conversations between physicians and patients about which tests and treatments are most appropriate and about avoiding care whose potential harm may outweigh its benefits.
Taskforce members initially proposed 30 items for consideration and debated the impact of each based on five criteria: evidence, prevalence, cost, relevance, and innovation. The list was then narrowed to 10 items which were analyzed with an in-depth evidence review and consultation with external content experts. Each item was scored on a scale of 1–5, rating each item on its overall impact as well as on each of the five criteria. The 5 items with the best mean overall scores were retained and reviewed by both societies’ executive committees. Both societies elected to endorse the final list.
The five recommendations for pulmonary medicine are:
- Don't perform computed tomography (CT) surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines.
- Don't routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (Groups II or III pulmonary hypertension).
- For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia.
- Don't perform chest computed tomography (CT angiography) to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.
- Don't perform CT screening for lung cancer among patients at low risk for lung cancer.
An ATS press release on the recommendations is available here.