Ethics and Terminology for Opting In and Out —In Reply

This study was carried out as a collaboration between research and clinical teams in a learning health system model. The clinical team recognized that a major barrier to BCS is that practitioners must both identify a patient who is due for screening and order the test when the patient is due. They decided to support the primary care teams by testing 2 strategies that could possibly reduce these barriers: (1) opt out, meaning to automatically order the test when it is due; and (2) opt in, meaning to send an automated telephone reminder to the patient who is due for screening. It was recognized by the clinical team that in either scenario patients could still decide whether to receive BCS and/or have further discussions with their primary care practitioners. We defined these strategies based on the behavioral economic principal of status quo or default bias, which encompass people ’s tendency to choose inaction vs action. We defined the opt-out option as not having to make a decision to select into the screening program and the opt-in option as the action of selecting into screening program. We used these terms based on these conceptual definitions. We recognize that these terms can be used in a variety of scenarios and hope our response provides clarity on the selection of these terms.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research