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  • Choosing Wisely Canada: The Canadian College of Medical Geneticists’ (CCMG) list of five items physicians and patients should question

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Clinical guidelines
Commentary
Choosing Wisely Canada: The Canadian College of Medical Geneticists’ (CCMG) list of five items physicians and patients should question
  1. Elaine Goh1,
  2. Andrea Guerin2,
  3. Joanna Lazier3,
  4. Sharan Goobie4,
  5. Tanya N Nelson5,6,
  6. Ron Agatep7,
  7. Victoria Mok Siu8,
  8. Karen Y Niederhoffer3,
  9. Julie Richer9
  1. 1 Department of Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, Canada
  2. 2 Department of Pediatrics, Division of Medical Genetics, Kingston General Hospital, Kingston, Canada
  3. 3 Department of Medical Genetics, University of Alberta, Edmonton, Canada
  4. 4 Medical Genetics, Department of Pediatrics, IWK Health Centre, Halifax, Canada
  5. 5 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
  6. 6 Department of Pathology and Laboratory Medicine, BC Children’s and BC Women’s Hospitals, Vancouver, Canada
  7. 7 Genomics, Diagnostic Services Manitoba, Winnipeg, Canada
  8. 8 Division of Medical Genetics, Department of Pediatrics, London Health Sciences Centre, Western University, London, Canada
  9. 9 Department of Medical Genetics, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
  1. Correspondence to Dr Elaine Goh, Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, ON L5M 2N1, Canada; elaine.goh{at}thp.ca

https://doi.org/10.1136/jmedgenet-2017-104924

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    Choosing Wisely Canada aims to reduce patient harm by promoting discussion and awareness of unnecessary tests, procedures and treatments. Organised by Canadian physicians and the Canadian Medical Association,1 it is modelled after the American Choosing Wisely campaign.2 The concept of ‘Choosing Wisely’ is now an international effort, across more than 15 countries.1

    The advances in genome sequencing technology have allowed for increased diagnostic yield while unmasking secondary findings or information of limited clinical utility.3 These findings may contribute to further unnecessary diagnostic testing, lifelong surveillance for low-risk sequelae and side effects of preventative treatment in healthy individuals, all of which may have economic consequences.3 Therefore, recommendations by genetics professionals to improve health and decrease costs are needed.

    The Canadian College of Medical Geneticists (CCMG) is the national organisation that establishes Canadian professional and ethical standards for medical genetics services. The CCMG through the leadership of the Ethics, Education, and Public Policy Committee (E2P2), undertook an iterative process to formulate five items physicians and patients should question in medical genetics as part of Choosing Wisely Canada.

    The initial statements (Summer 2015) were generated by a subcommittee of E2P2. Seven statements with the option for additions were presented in a pilot survey at the 2015 CCMG annual conference. For reference, the five statements from the American Choosing Wisely campaign were also provided.4 After feedback, the statements from the pilot survey were modified or replaced by new ones and distributed to the entire CCMG membership (n=318) by electronic survey (SurveyMonkey, San Mateo, California, USA) in March 2016 for ranking. Answers were weighted, and the five top statements were selected. The results of statement …

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    Footnotes

    • Contributors ES-YG wrote the first draft of the manuscript, coordinated the revisions and submitted the manuscript. JR led the campaign, created, analysed and administered the surveys, presented the statements at the annual meetings and collected feedback. ES-YG, AG, JL, KYN and JR each wrote a statement rationale. ES-YG, AG, SG, TNN, RA, VMS, KYN and JR helped in the brainstorming discussions that led to the statement formulation as well in refining statement rationale. All authors commented on various versions of the manuscript, agreed on the final version to be published and can attest to the integrity of the work.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.