Pathology-related Choosing Wisely recommendations

2018 Recommendations

1. Avoid unnecessary duplicate genetic testing for inherited variants

Evidence/guidance

Patient information/decision aids

Genetic testing can help identify a disease risk or inherited condition.  The results can help your doctor decide:

  • Which additional tests, if any, are required
  • Help to confirm a suspected diagnosis from previous tests undertaken
  • Choose ways to prevent or treat a condition.

Genetic testing may also tell you which family members are at risk.

However, sometimes a genetic test is not the best way to identify a disease risk or inherited condition. A routine blood test or procedure might be just as good. Therefore, it is important you discuss and understand the reasons for a genetic test with your doctor before agreeing to have a sample taken for testing.

Repeat testing

Usually you don’t need to repeat a genetic test.

Your genetic information generally doesn’t change over your lifetime. Your doctor should check with you directly to confirm whether you have previously had the test. There is usually no reason to repeat a genetic test unless:

  • Your doctor thinks an error may have been made in the laboratory performing the test.
  • A new, more accurate test is available

2. Don’t give a patient a blood transfusion without informing them about the risks and benefits (although do not delay emergency transfusions)

Evidence/guidance

There is a lack of high-quality research in this field with largely observational data available. The evidence suggests that patients have a limited understanding of many aspects of transfusion, but that they do want to be part of an informed decision-making process. The evidence also indicates that patients are reassured by the provision of written information.

Patient information\decision aids

A number of patient information materials are available through the NHSBT website:

3. Don’t transfuse red cells for iron deficiency anaemia without haemodynamic instability

Evidence\guidance

Patient information\decision aids

4. Use statins in appropriate patients

Evidence\guidance

Patient information\decision aids

2016 Recommendations

1. Unless a patient is at increased risk of prostate cancer because of race or family history, PSA testing does not necessarily lead to a longer life.

Patient information/decision aids

Evidence/guidance

2. Calcium testing is used when there are symptoms of kidney stones, bone disease or nerve-related disorders; but it is not necessary to test less than three months after the previous test except in acute conditions, during major surgery or in critically ill patients when tests should not be made more often than every 48 hours.

3. Only consider transfusing platelets for patients with chemotherapy-induced thrombocytopenia where the platelet count is < 10 x 109/L except when the patient has clinical significant bleeding or will be undergoing a procedure with a high risk of bleeding.

4. Use restrictive thresholds for patients needing red cell transfusions and give only one unit at a time except when the patient has active bleeding.

Evidence/guidance

5. Only transfuse O Rh D negative red cells to O Rh D negative patients and in emergencies for females of childbearing potential with unknown blood group.