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Table 4 Stakeholder perspectives on how the public should be involved in reducing low-value care

From: Understanding the public’s role in reducing low-value care: a scoping review

Study Country Study design Stakeholder Setting Low-value practice(s) Strategy for public involvement Supportive of strategy?
Demand-side stakeholdersa
Kullgren [31] 2018 USA Focus groups Patients (seniors) Not specified Multiple (potentially harmful medications, cancer screening) Shared decision-making Yes; patients felt that understanding risks and benefits and reaching a personalized decision would help them support CW recommendations
Linsky [32] 2014 USA Interviews and focus groups Patients Primary care Unnecessary medications Shared decision-making Yes; main theme from focus groups and interviews was the importance of strong patient-provider relationships, trust, and SDM for reducing unnecessary medications
Hislop [33] 2011 UK Interviews Community members Government Low-value care in general Citizen involvement in disinvestment decision-making No; community members interviewed felt that taxpayers do not have the knowledge and impartiality required to be involved in decision-making
Rohrbacher [34] 2008 Germany Telephone survey Patients Not specified Low-value care in general Shared decision-making Yes; patients want to discuss their preferences and personal experiences with their physician to arrive at the most evidence-based decision
Schoenborn [35] 2017 USA Interviews Patients (seniors) Ambulatory clinic Cancer screening when life expectancy is limited Shared decision-making Yes; patients indicated preference for a trusting relationship with their physician and an individualized decision-making process
Supply-side stakeholdersb
Daniels [36] 2018 UK Q study and interviews Physicians and administrators Government Low-value care in general Citizen Involvement in disinvestment decision-making Yes (cautious); participants held an overall supportive but cautious stance to citizen involvement
Kanzaria [37] 2015 USA Survey ED physicians ED Advanced diagnostic imaging Educating patients and families on low-probability outcomes and shared decision-making Ninety-two percent of emergency physicians surveyed and indicated that SDM would be helpful in reducing low-value diagnostic imaging
Scales [38] 2017 USA Survey Physicians and nurses Long-term care homes Unnecessary antibiotics Educating residents and families about why antibiotics are not necessary Yes; survey findings supported education as a tool to help reduce unnecessary antibiotic use
Ellen [39] 2018 Israel Interviews Nurses Outpatient clinic Low-value care in general Educating patients on the dangers of overuse Yes; interview findings indicate that nurses support the need to educate patients about overuse
Embrett [40] 2018 Canada Focus groups Physicians Not specified Low-value care in general Engaging patients in a conversation about low-value care in the clinical encounter Yes; a principal finding from the focus groups was the need for the Choosing Wisely campaign to help facilitate patient conversations about low-value care during the clinical encounter
  1. ED emergency department
  2. aStakeholders that receive health care (e.g., patients and community members)
  3. bStakeholders that contribute to the provision of health care (e.g., physicians and policy makers)