Discussion
This study sought to assess the impact of the consumer Choosing Wisely questions, both alone and in combination with an additional video intervention, using a randomized design. Both the Choosing Wisely Questions and SDM Preparation Video performed significantly better than control for improving participants’ intention to engage in SDM immediately post-intervention but not at 2-wk follow-up. Both interventions, whether presented independently or combined, also resulted in participants identifying significantly more questions that align with Choosing Wisely, including after 2 wks. We found some evidence that the video improved outcomes compared with control in ways that the Choosing Wisely questions alone did not, including lower intention to follow a low-value treatment plan without further questions and more positive attitude toward SDM. We also found that combining the video and Choosing Wisely questions led to a greater increase in intention to engage in SDM at immediate follow-up than presenting the Choosing Wisely questions alone. However, neither intervention changed participants’ self-efficacy to ask questions and be involved in decision-making, which was already high in this study, nor affected perceptions of preparedness to engage in SDM or knowledge of rights to be involved in healthcare decision-making.Our findings align with and extend previous research. Building on primarily descriptive findings related to the reach of the consumer Choosing Wisely questions, this is the first study to show an impact of these questions on consumer outcomes in the context of low-value care, including on recall and intentions to engage in SDM. We also observed some modest benefits of an SDM preparation video compared with control and the Choosing Wisely questions. This aligns with suggestions that people may need additional support to be involved in decision-making (e.g., reassurance that participation would not result in retributionDespite some positive impacts, interventions in this study did not uniformly improve all outcomes, including several outcomes for which there is a theoretical relationship. Models of behavior change, for example, often assume that self-efficacy expectations will significantly increase the prediction of behavioral intentions.There were also several variables included in this study with some level of conceptual overlap (e.g., preparedness for SDM and self-efficacy). Although outside the scope of our preplanned analysis, it would be useful to explore the predictive value of individual variables on patient outcomes in both hypothetical and clinical research settings.Despite some significant findings, effect sizes for all interventions were small, as has been the case for other SDM interventions in low-value care contexts.