De-adoption refers to the discontinuance of a medical practice or health service found to be ineffective or harmful following a previous period of adoption. As growing healthcare budgets threaten to cripple the societies that fund them, facilitating de-adoption may be integral to sustainable healthcare systems that provide high-quality care. This article explores ethical issues pertinent to de-adoption including the underpinnings of beneficence, non-maleficence, justice, and autonomy.
Get full access to this article
View all access options for this article.
References
1.
Second International Study of Infarct Survival (ISIS-2). Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. Lancet. 1988;332(8607):349–360.
2.
Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Investigators. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet. 1999;354(9180):716–722.
3.
EchtDSLiebsonPRMitchellLB. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324(12):781–788.
4.
PrasadVCifuA. Medical reversal: why we must raise the bar before adopting new technologies. Yale J Biol Med. 2011;84(4):471–478.
5.
PrasadVGallVCifuA. The frequency of medical reversal. Arch Intern Med. 2011;171(18):1675–1676.
6.
RogersEM. Diffusion of Innovations. 5th ed. New York, NY: Free Press; 2003.
7.
NivenDJMrklasKJHolodinskyJK. Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC Med. 2015;13(1):255.
8.
NivenDJRubenfeldGDKramerAAStelfoxHT. Effect of published scientific evidence on glycemic control in adult intensive care units. JAMA Intern Med. 2015;175(5):801–809.
9.
BeauchampTChildressJ. Principles of Bioethics. 7th ed. Oxford, England, UK: Oxford University Press; 2013.
10.
GlasdamSOeyeCThrysoeeL. Patients’ participation in decision-making in the medical field—‘projectification’ of patients in a neoliberal framed healthcare system. Nurs Philos. 2015;16(4):226–238.
11.
HoweEG. How to retain the trust of patients and families when we will not provide the treatment they want. J Clin Ethics. 2015;26(2):89–99.
12.
WinklerJDLohrKNBrookRH. Persuasive communication and medical technology assessment. Arch Intern Med. 1985;145(2):314–317.
13.
BantaHDThackerSB. The case for reassessment of healthcare technology. Once is not enough. JAMA. 1990;264(2):235–240.
14.
IoannidisJPA. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294(2):218–228.
15.
GarnerSLittlejohnsP. Disinvestment from low value clinical interventions: NICEly done?BMJ. 2011;343:d4519.
16.
CasselCKGuestJA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–1802.
17.
American Board of Internal Medicine Foundation. Choosing Wisely: Five Things Physicians and Patients Should Question. 2012. Available at: http://www.choosingwisely.org. Accessed March 4, 2014.
MalhotraAMaughanDAnsellJ. Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine. BMJ. 2015;350:h2308.
20.
O’CallaghanGMeyerHElshaugAG. Choosing wisely: the message, messenger and method. Med J Aust. 2015;202(4):175–177.
21.
RosenbergAAgiroAGottliebM. Early trends among seven recommendations from the Choosing Wisely Campaign. JAMA Intern Med. 2015;175(12):1913–1920.
22.
MordenNECollaCHSequistTDRosenthalMB. Choosing wisely—the politics and economics of labelling low-value services. N Engl J Med. 2014;370(7):589–592.
23.
GarnerSDochertyMSomnerJ. Reducing ineffective practice: challenges in identifying low-value healthcare using Cochrane systematic reviews. J Health Serv Res Policy. 2013;18(1):6–12.
24.
KastnerMTriccoACSoobiahC. What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Med Res Methodol. 2012;12:114.
25.
PrasadVIoannidisJP. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci. 2014;9(1):1.
26.
MontiniT, Graham ID. “Entrenched practices and other biases”: unpacking the historical, economic, professional, and social resistance to de-implementation. Implement Sci. 2015;10:24.
27.
GrahamIDLoganJHarrisonMB. Lost in knowledge translation: time for a map?J Contin Educ Health Prof. 2006;26(1):13–24.
28.
StaffordRSRadleyDC. National trends in antiobesity medication use. Arch Intern Med. 2003;163(9):1046–1050.
29.
SchwartzALChernewMELandonBEMcWilliamsJM. Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program. JAMA Intern Med. 2015;175(11):1815–1825.
30.
DuhiggC. The Power of Habit: Why We Do What We Do in Life and Business. New York, NY: Random House Trade Paperbacks; 2012.
31.
PandeyAKheraRKumarNGolwalaHGirotraSFonarowGC. Use of pulmonary artery catheterization in US patients with heart failure, 2001-2012. JAMA Intern Med. 2016;176(1):129–132.
32.
StrausSETetroeJGrahamID. Knowledge Translation in Health Care: Moving from Evidence to Practice. 2nd ed. Oxford, UK: John Wiley, Ltd; 2013.
