Five things physicians and patients should question in hospice and palliative medicine

Daniel Fischberg, Janet Bull, David Casarett, Laura C. Hanson, Scott M. Klein, Joseph Rotella, Thomas Smith, C. Porter Storey, Joan M. Teno, Eric Widera

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Overuse or misuse of tests and treatments exposes patients to potential harm. The American Board of Internal Medicine Foundation's Choosing Wisely® campaign is a multiyear effort to encourage physician leadership in reducing harmful or inappropriate resource utilization. Via the campaign, medical societies are asked to identify five tests or procedures commonly used in their field, the routine use of which in specific clinical scenarios should be questioned by both physicians and patients based on the evidence that the test or procedure is ineffective or even harmful. The American Academy of Hospice and Palliative Medicine (AAHPM) was invited, and it agreed to participate in the campaign. The AAHPM Choosing Wisely Task Force, with input from the AAHPM membership, developed the following five recommendations: 1) Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral-assisted feeding; 2) Don't delay palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease-directed treatment; 3) Don't leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care; 4) Don't recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis; and 5) Don't use topical lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®) (ABH) gel for nausea. These recommendations and their supporting rationale should be considered by physicians, patients, and their caregivers as they collaborate in choosing those treatments that do the most good and avoid the most harm for those living with serious illness.

Original languageEnglish (US)
Pages (from-to)595-605
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number3
StatePublished - Mar 2013
Externally publishedYes


  • ABH gel
  • Choosing Wisely®
  • ICD
  • PEG
  • artificial nutrition and hydration
  • bone metastasis
  • bone pain
  • dementia
  • heart failure
  • implantable cardioverter-defibrillator
  • lorazepam-haloperidol-diphenhydramine gel
  • nausea
  • palliative care
  • percutaneous endoscopic gastrostomy
  • quality of life
  • single-fraction radiation

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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