Increasing colonoscopies? A psychological perspective on opting in versus opting out.

Abstract

Although modifying the default to an opt-out system has been shown to be effective in some health care procedures, the current results reveal this system is not always effective in producing the healthiest medical behaviors. Our research, then, suggests that opt-out paradigms are not an overall panacea for increasing participation in preventive health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Factors Associated With Missed and Cancelled Colonoscopy Appointments at Veterans Health Administration Facilities

“…Our finding that appointment lead time, season of referral, and opt-out scheduling were significantly associated with missed appointment rates is consistent with prior studies documenting similar associations in outpatient endoscopy settings, 8,10,12,14,18 and our finding that marital status, residence, drive time, and comorbidities were associated with at least 1 of the outcomes examined is consistent with prior studies documenting similar associations in general practice settings. [28][29][30] However, some of our findings contrast with findings from prior studies.…”

“…Prior studies examining factors associated with missed and cancelled appointments in outpatient endoscopy clinics have identified a number of predictors, including patient age [8][9][10][11][12] and gender, 13 appointment lead time (ie, number of days between the scheduling date and appointment date), 8,10,12 season of referral, 14 and organizational-level improvement strategies such as appointment reminders, 8,[15][16][17] opt-in scheduling (ie, requiring patients to call to initiate scheduling), 18 and peer coaching. 11 To our knowledge, no prior studies examining outpatient endoscopy clinic appointments have distinguished between cancelled and missed appointments.…”

“…21,22 We received 82 completed surveys from the 101 Gastroenterology Chiefs recruited (81% response rate). 21,22 We included 3 measures from this survey found to be associated with endoscopic completion rates in prior studies 8,[15][16][17]21 : (1) scheduling approach (opt-out, which involves mailing patients an assigned appointment date and time versus opt-in, which requires patients to call to schedule), 18 (2) preparation instruction method (written instructions only, some verbal instruction provided verbally by phone or in an individual appointment, or combined verbal and written instruction provided in a group appointment or other format), 21 and (3) appointment reminders (none, reminder with or without preparation instruction review). 8,[15][16][17] Question wording and coding for analysis are provided in Table 1.…”

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

“…For example, rates of organ transplantation are higher in countries with opt‐out preference indication for organ donation (presumed consent) than in countries with opt‐in preference indication (explicit consent) 27. In some studies, participant recruitment has been shown to be enhanced by an opt‐out structure,28 while in others, an opt‐out structure may have caused perceived loss of autonomy that led to reduced recruitment 29. On the other hand, preselection of orders (“default to prescribe” mode) within order sets has in some contexts dramatically increased prescription rates,30 but such practices have the potential to infringe on provider autonomy and may increase the potential for errors (eg, automatic prescription despite an allergy or drug interaction known to the provider).…”

“…27 In some studies, participant recruitment has been shown to be enhanced by an opt-out structure, 28 while in others, an optout structure may have caused perceived loss of autonomy that led to reduced recruitment. 29 On the other hand, preselection of orders ("default to prescribe" mode) within order sets has in some contexts dramatically increased prescription rates, 30 but such practices have the potential to infringe on provider autonomy and may increase the potential for errors (eg, automatic prescription despite an allergy or drug interaction known to the provider). In the intervention analyzed in our study, the change from opt-in to opt-out was introduced with a relatively "soft touch" (a requirement to address the statin section) that maintained provider autonomy and yet was still associated with increased prescribing behavior.…”