Choosing Wisely 5 Questions giving confidence to clinicians
Darling Downs Health used the Choosing Wisely 5 Questions to help their rural patients ask questions of their healthcare teams, however, feedback made it clear that local doctors wanted support to help respond. The program was broadened to include medical staff and a printable resource was created to support health professionals have these discussions with their patients. Early evidence suggests this has led to an even stronger program with increased benefits for both patients and doctors.
In 2019, Queensland’s Darling Downs Health integrated the Choosing Wisely 5 Questions into patient care after consumer and community engagement officer, Donna Lucas, attended a Choosing Wisely forum.
Darling Downs Health provides hospital, community, and primary health services to about 300,000 people across 90,000 square kilometres in southern Queensland. The population is older than Australia’s average, and it was felt that local people weren’t confident about asking questions and more likely to be passive in their relationships with their health professionals.
Says Donna: “We wanted to conduct a large-scale, service-wide initiative that would bring patients and their families together with healthcare professionals to improve the patient journey and their level of care.” A program was mapped out.
- The 5 Questions program was first presented to rural senior managers and discussed at sectional and divisional meetings.
- General staff forums and question and answer sessions were held.
- The Choosing Wisely 5 Question wallet cards were distributed internally and shared externally with patient support groups. The campaign was promoted on social media.
- Posters were placed in patients’ hospital rooms and in common areas. Information was displayed on hospital digital boards.
- The cards were included in patients’ hospital admission packs and nursing staff were asked to go through the 5 Questions with their patients on admittance.
- It was seen as important to include patients’ families. Cards were left on bedside tables and handed to family members who were encouraged to be present at ward rounds and family meetings. In this way they could use the prompts on the cards to gather more information about their loved ones’ care.
Director of Medical Services for the western region, Dr Chris Cowling has been a key figure in driving the program. Based at Dalby Hospital, more than 200 kilometres north-west of Brisbane, he says for a multitude of factors, rural and remote communities sometimes need help in understanding their healthcare journey. “The days of the infallible doctor are long gone, but patients in rural areas, particularly elderly patients, tend to be very compliant with the advice their healthcare professional provides them. Using cards as a prompt for them to start a conversation about their conditions and needs is giving them permission to respectfully question the rationale of recommended therapies and explore the availability of alternative treatments.”
Helping clinicians respond to patient questions
As the initiative got underway it soon became clear that to be successful, clinicians needed to be brought into the mix. Doctors attending meetings expressed a desire for support.
Initially, there was a degree of uncertainty among medical staff. “This was probably to be expected”, says Chris. “Firstly, they needed to see the benefit to patients in having them enquire about their care. Secondly, there was a need to support doctors to respond to the five questions.”
“At our regular meetings we explored their concerns and provided reassurance. We discussed that it was an opportunity for us to engage patients in their healthcare journey and increase their health literacy.”
“It was also an opportunity for us as a profession to question the reasons for, and the evidence behind, what we have traditionally done. It not only helped patients gain knowledge but also us as practitioners to reflect on our decisions. We could minimise unnecessary interventions.”
The services’ medical education team were brought in to help. Doctors’ information sheets were developed that set out suggested responses to patients’ 5 Questions and included sections encouraging doctors to reflect on their decisions.
Early feedback from doctors has been that the initiative has provided them with reassurance that their patients understand their health, are able to ask questions, and our doctors are empowered to answer patient’s questions.
Some patients are using the cards, but not all. The most frequent engagement with the cards seems to be when patients are needing end of life care and they and their families are making decisions about treatment options. Says Chris: “This, I think, is a really lovely benefit that I had not foreseen with the Choosing Wisely initiative.”
Stewardship toolkit for clinical educators
The Health Resource Stewardship for Clinical educators contains educational material about the Choosing Wisely initiative for use in universities, hospitals and health professional colleges
5 questions to ask your doctor or other healthcare provider to make sure you end up with the right amount of care.