The report Choosing Wisely means Choosing Equity recommends a number of changes to make the Choosing Wisely campaign more effective for Māori. The research was undertaken by Anna Adcock, and commissioned by Te Ohu Rata o Aotearoa (Te ORA) in partnership with Choosing Wisely, which is a campaign facilitated in New Zealand by the Council of Medical Colleges.
Choosing Wisely is an international campaign that aims to reduce unnecessary tests and treatments to ensure high-quality health care by promoting better shared decision-making between health professionals and consumers.
Although the health system in Aotearoa New Zealand acknowledges Te Tiriti o Waitangi principles of partnership, participation, and protection, and aspires to health equity, Māori experience marked inequities in health outcomes, mortality, health care access and satisfaction with health services.
Choosing Wisely partnered with Te ORA on this research to ensure that it is implemented in an appropriate way for Māori and does not increase inequity.
Te ORA Chair, Professor David Tipene-Leach, says while the Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatments, this must not be at the expense of equity – and particularly the health of Māori.
'Unless equity is explicitly considered, new health care interventions or campaigns have the tendency to widen inequities, as they are taken up first by those in society with the most resources and the least need.'
Dr Derek Sherwood, the Choosing Wisely clinical lead noted that 'the research aimed to develop an in-depth understanding of Māori health consumers and health providers/practitioners’ perspectives on health care shared decision-making, and make recommendations for strategies to inform an equity focused Choosing Wisely campaign. Anna Adcock a researcher was contracted by Te Ora and Choosing Wisely to do this work.'
Anna talked with Māori health care consumers and Māori health professionals from a range of professions, including general practice, nursing, midwifery and pharmacy.
'We discussed their views on Choosing Wisely as a campaign, and whether they see value in it for Māori. This includes shared decision-making – what makes a good environment for shared decision-making, and how Choosing Wisely could promote it.
'We also covered things like whether the Choosing Wisely resources are appropriate for Māori, if consumers or health professionals see any potential barriers for the campaign, and whether there could be a greater equity focus for Māori.'
Professor Tipene-Leach says feedback about the campaign was mixed.
'Concerns were raised about the campaign governance and that level of decision-making – that it has not engaged with Māori communities and Māori health professional groups, and that it lacks reflection of mātauranga Māori (Māori knowledge systems) and tikanga Māori (Māori practices and customs). These are all important for not undermining the principles of Te Tiriti o Waitangi.'
'There was feedback that narrow campaign messages focusing on reducing tests and treatments are problematic. Having Māori patients themselves having to initiate the questions around medical advice is also difficult. But value was seen in the campaign if it promotes better communication between Māori consumers and their health providers. The caveat is that health providers must be delivering appropriate care and opening conversations that encourage shared decision-making.'
Māori whānau and health professionals both said resources needed to be simple and realistic, as well as socially and culturally engaging for Māori.
Anna Adcock says the research corroborates themes found in other research on shared decision-making with indigenous people – that it has potential to address health inequities, but consumers must know they have the right to ask questions, and providers must be open to having these conversations.
Report recommendations include:
Choosing Wisely campaign
- Uphold Te Tiriti o Waitangi and centre Māori in governance and decision-making.
- Acknowledge and incorporate mātauranga Māori (Māori knowledge systems) and tikanga Māori (Māori practices and customs) in Choosing Wisely work.
- Consider including messages that encourage health providers to consider the best options for consumers and to instigate shared decision-making, such as, ‘advise wisely’.
- Use local evidence to support the campaign.
- Promote cultural safety, patient-centred care, quality improvement and equity based training.
- Undertake work to ensure that consumers know they have the right to ask questions.
Choosing Wisely resources
- Work with Māori to design resources/tools that are engaging and relatable for Māori.
- Develop resources/tools to encourage health providers to communicate efficaciously.
- Create resources/tools for advocates, to support/promote shared decision-making.
- Support the development of decision-making tools for specific health issues.
- Advertise and supply resources/tools and key messages among networks and within health settings so that they become routine. Consider media/online tools.
- Seek user feedback from providers and consumers about resources/tools through networks, such as Te ORA, and health services.
The report is available on the Choosing Wisely website.