Choosing wisely Wales has received further payment from Welsh Government for 2017 -2018 to fund clinical leadership and support patient involvement. Public Health Wales has also provided funding as part of its Patient Centred Care Programme. Wayne Jepson of 1000 lives is providing programme management and we are getting a lot of input regarding coproduction and evaluating patient experience from 1000 lives team.
Our agreement with Welsh Government is to focus on decision making in advanced cancer and we are working with Velindre NHS Trust and Betsi Cadwaladr Cancer services. We have a multidisciplinary professional and lay steering group to guide our activity. We continue to meet with professional and public groups to talk about Choosing wisely which we are branding as “Making Choices together” to avoid confusion with the Choose Well programme. This is to stress the shared decision making aspect of the Choosing wisely movement.
Paul Myres attended the Choosing wisely International Roundtable in Amsterdam in September. There are over 20 countries now adopting the principles of Choosing wisely and fifteen were represented at the workshop. All are focussing on producing lists of low value tests and treatments to avoid but few are successfully implementing at present. We think this may be because not all are recognising the need for a behavioural change approach to influence clinicians to change their interactions with patients and make best use of interventions. Several are working well with patient groups.
Progress is slow but the successful countries are advising to focus on a few areas and be prepared for it to take several years. Winning over clinicians and patients and in particular showing how it benefits them personally is essential. What we are finding is that we also need support (but not direction) from employing/ provider organisations.
We will be appointing clinical leads in Velindre and BCUHB shortly and are meeting patient groups in cancer care. We will be providing training in Choosing wisely principles and shared decision making to clinical teams in both these organisations over the next few weeks. This work fits in well with the Academy interest in helping doctors have better conversations regarding prognosis and the effectiveness of cancer altering treatments towards the end of life.