Presumed Consent With Opt-Out: An Ethical Consent Approach to Automatically Refer Patients With Cancer to Tobacco Treatment Services

Ohde, Joshua W.; Master, Zubin; Tilburt, Jon C.; Warner, David O.

doi:10.1200/jco.20.03180

Cited by 8 publications

(11 citation statements)

References 44 publications

(55 reference statements)

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“…Ethical considerations around such opt-out strategies have determined that the benefits outweigh the risks for patients, and can enhance the medical community’s obligation to treat tobacco dependence. 16 …”

Section: Discussionmentioning

confidence: 99%

A Proactive Outreach Strategy Using a Local Area Code to Refer Unassisted Smokers in a Safety Net Health System to a Quitline: A Pragmatic Randomized Trial

Valencia

Dove

Cummins

et al. 2022

Nicotine &Amp; Tobacco Research

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Introduction Proactive outreach offering tobacco treatment is a promising strategy outside of clinical settings, but little is known about factors for engagement. The study objective is to examine the impact of caller area code in a proactive, phone-based outreach strategy on consenting low-income smokers to a quitline e-referral. Aims and Methods This pragmatic randomized trial included unassisted adult smokers (n = 685), whose preferred language was English or Spanish, in a Los Angeles safety-net health system. Patients were randomized to receive a call from a local or generic toll-free area code. Log-binomial regression was used to examine the association between area code and consent to a quitline e-referral, adjusted for age, gender, language, and year. Results Overall, 52.1% of the patients were contacted and, among those contacted, 30% consented to a referral. The contact rate was higher for the local versus generic area code, although not statistically significant (55.6% vs. 48.7%, p = .07). The consent rate was higher in the local versus generic area code group (adjusted prevalence ratio 1.29, 95% CI 1.01–1.65) and also higher for patients under 61 years old than over (adjusted prevalence ratio 1.47, 95% CI 1.07–2.01), and Spanish-speaking than English-speaking patients (adjusted prevalence ratio 1.40, 95% CI 1.05–1.86). Conclusions Proactive phone-based outreach to unassisted smokers in a safety net health system increased consent to a quitline referral when local (vs. generic) area codes were used to contact patients. While contact rate did not differ by area code, proactive phone-based outreach was effective for engaging younger and Spanish-speaking smokers. Implications Population-based proactive phone-based outreach from a caller with a local area code to unassisted smokers in a safety net health system increases consent to an e-referral for quitline services. Findings suggest that a proactive phone-based outreach, a population-based strategy, is an effective strategy to build on the visit-based model and offer services to tobacco users, regardless of the motivational levels to quit.

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Section: Discussionmentioning

confidence: 99%

A Proactive Outreach Strategy Using a Local Area Code to Refer Unassisted Smokers in a Safety Net Health System to a Quitline: A Pragmatic Randomized Trial

Valencia

Dove

Cummins

et al. 2022

Nicotine &Amp; Tobacco Research

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“…22,23 An "opt-out" approach can improve the reach of tobacco cessation services because patients who are motivated but may not express readiness during their visit owing to lack of confidence will still be referred to cessation treatment. 7,44,45 Because some patients may not be sufficiently motivated to participate in cessation services at the start of cancer treatment, it is imperative to offer cessation programs at multiple points along the cancer care continuum from prediagnostic testing, to treatment, and throughout follow-up care. 7,24 Patients treated in a multidisciplinary clinic meet with providers at every step of the continuum, allowing providers to promote cessation throughout the entirety of care.…”

Section: Discussionmentioning

confidence: 99%

“…Cessation treatment is moving toward an “opt-out” approach, in which all patients are referred to cessation services regardless of quit readiness. 43 , 44 , 45 Among 2765 patients with cancer who smoked and received oncology services at the Roswell Park Cancer Institute, half received a mail invitation to contact a cessation service whereas the other half received the mailing plus telephone cessation support initiated by the Roswell Park Cancer Institute. Whereas only 1.2% of patients who received the mailing only contacted the cessation service, among patients who received the mailing plus telephone support, 4.5% reported at follow-up no tobacco use for the past 30 days and only 2.7% declined to participate.…”

Section: Discussionmentioning

confidence: 99%

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Interest in Cessation Treatment Among People Who Smoke in a Community-Based Multidisciplinary Thoracic Oncology Program

Meadows‐Taylor¹,

Ward

Chen

et al. 2021

JTO Clinical and Research Reports

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Introduction: To evaluate the need for tobacco cessation services within a multidisciplinary clinic (MDC), we surveyed patients on their smoking status, interest in quitting, and willingness to participate in a clinic-based cessation program. We further evaluated the association between interest in cessation or willingness to participate in a cessation program and overall survival (OS).Methods: From 2014 to 2019, all new patients with lung cancer in the MDC at Baptist Cancer Center (Memphis, TN) were administered a social history questionnaire to evaluate their demographic characteristics, smoking status, tobacco dependence, interest in quitting, and willingness to participate in a cessation program. We used chi-square tests and logistic regression to compare characteristics of those who would participate to those who would not or were unsure and Kaplan-Meier curves and Cox regression to evaluate the association between cessation interest or willingness to quit and OS.Results: Of 641 total respondents, the average age was 69 years (range: 32-95), 47% were men, 64% white, 34% black, and 17% college graduates. A total of 90% had ever smoked: 34% currently and 25% quit within the past year. Among the current smokers, 60% were very interested in quitting and 37% would participate in a cessation program. Willingness to participate in a cessation program was associated with greater interest in quitting (p < 0.0001), better OS (p ¼ 0.02), and reduced hazard of death (hazard ratio ¼ 0.52, 95% confidence interval: 0.30-0.88), but no other characteristics.Conclusions: Patients with lung cancer in an MDC expressed considerable interest in tobacco cessation services; patients willing to participate in a clinic-based cessation program had improved survival.

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“…162 This "opt-out" proposal has generated controversy but satisfies accepted principles of medical ethics. 163 Initial studies exploring this approach in cancer and hospitalized patients have produced encouraging results, but more work is needed to compare its effectiveness with the "opt-in" strategy. [164][165][166]…”

Section: Other Approachesmentioning

confidence: 99%

Anesthesiologists and the Other Pandemic: Tobacco Use

Warner

2022

Anesthesiology

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Tobacco use will kill a projected 1 billion people in the 21st century in one of the deadliest pandemics in history. Tobacco use disorder is a disease with a natural history, pathophysiology, and effective treatment options. Anesthesiologists can play a unique role in fighting this pandemic, providing both immediate (reduction in perioperative risk) and long-term (reduction in tobacco-related diseases) benefits to their patients who are its victims. Receiving surgery is one of the most powerful stimuli to quit tobacco. Tobacco treatments that combine counseling and pharmacotherapy (e.g., nicotine replacement therapy) can further increase quit rates and reduce risk of morbidity such as pulmonary and wound-related complications. The perioperative setting provides a great opportunity to implement multimodal perianesthesia tobacco treatment, which combines multiple evidence-based tactics to implement the four core components of consistent ascertainment and documentation of tobacco use, advice to quit, access to pharmacotherapy, and referral to counseling resources.

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Presumed Consent With Opt-Out: An Ethical Consent Approach to Automatically Refer Patients With Cancer to Tobacco Treatment Services

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 8 publications

References 44 publications

A Proactive Outreach Strategy Using a Local Area Code to Refer Unassisted Smokers in a Safety Net Health System to a Quitline: A Pragmatic Randomized Trial

A Proactive Outreach Strategy Using a Local Area Code to Refer Unassisted Smokers in a Safety Net Health System to a Quitline: A Pragmatic Randomized Trial

Interest in Cessation Treatment Among People Who Smoke in a Community-Based Multidisciplinary Thoracic Oncology Program

Anesthesiologists and the Other Pandemic: Tobacco Use

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