What influences clinicians to choose wisely?

To evaluate the effectiveness of awareness-raising by the Choosing Wisely campaign in a New Zealand public hospital to reduce routine pre-operative testing and to determine what can be done to bring about change in clinician behaviour.

Short, semi-structured, one on-one interviews were conducted with 15 doctors of varying seniority from general surgery who were exposed to the campaign between August and October 2018. The interviews covered four general topics including background information, asking about awareness and effectiveness of Choosing Wisely campaign, exploring barriers to changing clinician behaviour around pre-operative testing and exploring potential interventions which may be useful to change behaviour. Data were analysed using Braun and Clarke thematic analysis methodology.

Four themes and 17 sub-themes emerged from the interviews. The main themes included awareness of Choosing Wisely, thoughts around pre-operative testing, barriers for changing clinician behaviour and strategies for reducing unnecessary pre-operative testing.

The findings of this study suggest that a strategy that relies on revising guidelines and raising staff awareness alone is likely to be of limited effectiveness in reducing unnecessary pre-operative testing. In addition to increasing clinician awareness of evidence-based recommendations on unnecessary testing, other strategies may be needed to support behaviour change.