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Evaluation of the Choosing Wisely Australia 5 Questions resource and a shared decision-making preparation video: protocol for an online experiment
  1. Danielle Marie Muscat1,
  2. Edward Hoi-fan Chang2,
  3. Rachel Thompson1,
  4. Erin Cvejic1,
  5. Marguerite Tracy2,
  6. Joshua Zadro3,
  7. Jessica Kathleen Smith2,
  8. Robyn Lindner4,
  9. Kirsten McCaffery1
  1. 1 Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
  4. 4 NPS Medicinewise, Strawberry Hills, New South Wales, Australia
  1. Correspondence to Dr Danielle Marie Muscat; danielle.muscat{at}


Introduction Choosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants’ health literacy modifies the effects of the interventions.

Methods and analysis We will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes).

Ethics and dissemination Ethical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion.

Trial registration number This trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.

  • patient participation
  • decision making
  • shared decision making
  • health literacy
  • question prompt list
  • medical overuse

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  • Twitter @ErinCvejic, @M_C_Tracy, @zadro_josh

  • Contributors Authorship decisions adhered to International Committee of Medical Journal Editors (ICMJE) recommendations. DM, KM and JKS conceived the original idea for this trial, and this was further developed by EH-fC, RET, EC, MT, JZ and RL. DM and JKS wrote the first draft of this protocol manuscript, and this was edited by all other authors. EC provided valuable input regarding trial design and analytical considerations, and performed the sample size calculations for the trial. All authors contributed to and approved the final version of the manuscript.

  • Funding The study was funded by a National Health and Medical Research Council (NHMRC; Program Grant (APP1113532). NPS MedicineWise gave permission for investigators’ use of the Question Prompt List leaflet without charge. EC was supported by a Sydney Medical School Summer Research Scholarship and KM was supported by an NHMRC Principal Research Fellowship (1121110). Neither the NHMRC nor Sydney Medical School had any role in the design of this study. They will not have a future role in the conduct or write-up of the study or in the decision to submit the findings for publication. A representative of Choosing Wisely Australia (RL) contributed to the design of this study and will have a future role in the conduct and write-up of the study. NPS MedicineWise will not have a role in the decision to submit the study findings for publication.

  • Competing interests RL is an employee of NPS MedicineWise which facilitates Choosing Wisely Australia. The University of Sydney owns intellectual property on the video and DM, MT, KM and RET are contributors to the intellectual property.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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