Choosing Wisely for Thyroid Conditions: Recommendations of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism

Jose Miguel Dora Rosa Paula Mello Biscolla Gustavo Caldas Janete Cerutti Hans Graf Ana O. Hoff Glaucia M. F. S. Mazeto Patrícia Kunzle Ribeiro Magalhães Cleo Otaviano Mesa Junior Rafael Selbach Scheffel Patricia de Fatima dos Santos Teixeira Fernanda Vaisman Danilo Villagelin Ana Luiza Maia on behalf of the Thyroid Department of the Brazilian Society of Endocrinology and MetabolismAbout the authors

ABSTRACT

Objective:

Choosing Wisely (CW) is an initiative that aims to advance the dialogue between physicians and patients about low-value health interventions. Given that thyroid conditions are frequent in clinical practice, we aimed to develop an evidence-based list of thyroid CW recommendations.

Materials and methods:

The Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) named a Task Force to conduct the initiative. The Task Force work was based on an electronic Delphi approach. The 10 recommendations that received the highest scores by the Task Force were submitted for voting by all SBEM associates. The 5 recommendations that received the highest scores by SBEM associates are presented herein.

Results:

The Task Force was composed of 14 thyroidologists from 10 tertiary-care, teaching-based Brazilian institutions. The brainstorming/ideation phase resulted in 69 recommendations. After the removal of duplicates and recommendations that did not adhere to the initiative's scope, 35 remained. Then the Task Force voted to attribute a grade (0 [lowest agreement] to 10 [highest agreement]) for each recommendation. The 10 recommendations that received the highest scores by the Task Force were submitted to all SBEM associates. A total of 683 associates voted electronically, attributing a grade (0 to 10) for each recommendation. The 5 recommendations that received the highest scores by the SBEM associates compose our final list.

Conclusion:

A set of recommendations to avoid unnecessary medical tests, treatments, or procedures for thyroid conditions are offered with a transparent methodology. This initiative aims to foster productive interactions between physicians and patients, stimulating shared decision-making.

Keywords
Choosing Wisely; overuse; thyroid; endocrinology

INTRODUCTION

The overuse of low-value interventions is a global problem. A growing body of knowledge highlights that it leads to a waste of precious health care resources and poses patients at risk of harm (11. Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156-68.).

Choosing Wisely is a worldwide health care professional-led initiative that aims to advance the dialogue between physicians and patients about low-value health interventions, avoiding wasteful or unnecessary medical tests, treatments, and procedures (22. Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA; Choosing Wisely International Working Group. ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf. 2015;24(2):167-74.,33. Born KB, Levinson W. Choosing Wisely campaigns globally: A shared approach to tackling the problem of overuse in healthcare. J Gen Fam Med. 2018;20(1):9-12.).

The Choosing Wisely initiative started in the United States in 2012 led by the American Board of Internal Medicine (ABIM) and is now present in many countries, involving more than one hundred medical associations/societies, hospitals, and universities.

Given that thyroid conditions are widespread and that low-value interventions for these conditions are frequent in clinical practice, we aimed to develop a list of recommendations of measures not to be done when approaching patients with thyroid conditions.

This article aims to summarize the top five recommendations in the list developed by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) for the Choosing Wisely project.

MATERIALS AND METHODS

In 2017 the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Choosing Wisely Brasil agreed to work towards the development of a list of Choosing Wisely recommendations for thyroid conditions.

The Thyroid Department named a Chair (JMD) and a Co-chair (ALM) for the initiative. Additional members of SBEM, representing thyroid groups from 10 tertiary care, teaching-based Brazilian institutions, were invited to compose the Task Force. Of note, all members of the Task Force were clinical thyroid specialists, not surgeons.

The Task Force work consisted of 3 phases:

  1. brainstorming and ideation was conducted electronically through a Delphi approach in which all Task Force members were invited to submit proposals of recommendations;

  2. all proposals of recommendations were reviewed, and duplicates removed;

  3. the Task Force graded each recommendation on a 0 (lowest agreement) to 10 (highest agreement) scale.

The 10 recommendations that received the highest scores by the Task Force were submitted for voting by e-mail to all SBEM associates, who graded each recommendation on the 0 (lowest agreement) to 10 (highest agreement) scale.

A final list of the 5 recommendations that received the highest scores by the SBEM associates composes the Choosing Wisely – Thyroid SBEM recommendations.

RESULTS

The Task Force was composed of 14 thyroidologists from 10 different Brazilian institutions. The brainstorming and ideation phase resulted in 69 recommendations, thus each member of the Task Force contributed with a median of 3 (min.-max. 1-11) recommendations. After the removal of duplicates and recommendations that did not adhere to the scope of the initiative, 35 recommendations remained. Then the 14 members of the Task Force graded each recommendation. The mean grades for the 35 recommendations ranged from 9.4 ± 1.2 to 6.0 ± 2.3. The 10 recommendations that received the highest scores by the Task Force were then submitted to all SBEM associates by e-mail (Table 1). A total of 683 associates graded each recommendation electronically, attributing a grade (0 to 10) for each recommendation. The grades for the 10 recommendations ranged from 9.8 ± 1.2 to 7.6 ± 2.7, and the 5 recommendations that received the highest scores by the SBEM associates compose our final list of recommendations (Table 2).

Table 1
Top 10 recommendations of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) Task Force
Table 2
Final Choosing Wisely® recommendations and rationale of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

The Portuguese version of the 5 recommendations is available as Supplementary Material.

CONCLUSION

In this report, we described the development of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) Choosing Wisely initiative list.

A set of recommendations to avoid unnecessary medical tests, treatments, or procedures for thyroid conditions is offered with a transparent methodology. This initiative aims to foster productive interactions between physicians and patients, stimulating shared decision-making and elevating the standards of care for thyroid conditions.

  • Financial support was received from Fundo de Incentivo à Pesquisa (FIPE/HCPA).
  • *
    Metodologia de confecção da seleção: o Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) nomeou uma Task Force, composta por 14 especialistas representando diferentes instituições nacionais, para elaborar a lista preliminar de recomendações. Foram elencadas 51 propostas de recomendações, selecionando as 10 melhores ranqueadas por pontuação de relevância clínica. Essas 10 recomendações foram submetidas a votação por todos os associados da SBEM durante os meses de abril e maio de 2 017. As 5 recomendações mais votadas pelos sócios da SBEM compuseram as recomendações TOP FIVE Choosing Wisely Brasil do Departamento de Tireoide da SBEM. (Contato:http://www.tireoide.org.br/contato/).
  • Estas recomendações estão disponibilizadas para fins informativos, e não se destinam a substituir a consulta ou avaliação com um profissional médico ou outro profissional da equipe da saúde envolvida na assistência. Pacientes com quaisquer perguntas específicas sobre os itens desta lista ou sua situação individual devem consultar seu médico.

Acknowledgements:

we are grateful to the Thyroid Department (Departamento de Tireoide) and to all members of the Sociedade Brasileira de Endocrinologia e Metabologia, who invested their precious time grading the recommendations for this initiative.

REFERENCES

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  • 2
    Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA; Choosing Wisely International Working Group. ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf. 2015;24(2):167-74.
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Supplementary Material

Publication Dates

  • Publication in this collection
    24 Feb 2021
  • Date of issue
    Mar-Apr 2021

History

  • Received
    02 July 2020
  • Accepted
    04 Sept 2020
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