Byron Gajewski, PhD, Explores Impact of Opt-Out Approach on Smoking Cessation Success

In an interview with The Educated Patient, Byron Gajewski, PhD, professor within the Department of Biostatistics and Data Science at the University of Kansas School of Medicine, discusses results of a study that showed offering smoking cessation tools, such as medication and counseling, to all smokers regardless of motivation increases participation and success rates in quitting.

The opt-in approach works like this: if a patient is identified as a smoker, they are asked, "Would you be interested in quitting smoking?" If the patient says yes, then the best practice is to offer them a prescription for medication to help with cravings, along with counseling. The patient receives both the prescription and the counseling.

The opt-out approach, Gajewski explains, is slightly different. In this case, when a smoker is identified, instead of asking whether they're interested in quitting, they are automatically provided with the prescription for medication and counseling, regardless of their stated interest. It’s similar to how high blood pressure is handled, he says. If your doctor finds you're hypertensive, they offer you medication without asking if you're interested in lowering your blood pressure. You have the option to refuse, but the offer is made automatically.

The reason the opt-out approach had a higher quit rate in the current study, regardless of a person's motivation to quit, is because more people engage with the best practices for quitting. This includes both medication to help manage cravings as well as counseling. Participation in these treatments was twice as high in the opt-out group compared to the opt-in group, simply because more people received the necessary tools for quitting.

Gajewski believes this study can greatly influence future smoking cessation programs and supports the idea that medicine, guided by research, can be an excellent tool for patients. Following the advice of healthcare professionals is crucial, he says, although that doesn’t mean patients shouldn’t advocate for themselves. Expertise is incredibly valuable when it comes to achieving better health outcomes.