title: It's time to change the default for tobacco treatment.
abstract: The World Health Organization estimates that 1 billion people will die from tobacco-related illnesses this century. Most health-care providers, however, fail to treat tobacco dependence. This may be due in part to the treatment 'default'. Guidelines in many countries recommend that health-care providers: (i) ask patients if they are 'ready' to quit using tobacco; and (ii) provide treatment only to those who state they are ready to quit. For other health conditions--diabetes, hypertension, asthma and even substance abuse--treatment guidelines direct health-care providers to identify the health condition and initiate evidence-based treatment. As with any medical care, patients are free to decline--they can 'opt out' from care. If patients do nothing, they will receive care. For tobacco users, however, the treatment default is often that they have to 'opt in' to treatment. This drastically limits the reach of tobacco treatment because, at any given encounter, a minority of tobacco users will say they are ready to quit. As a result, few are offered treatment. It is time to change the treatment default for tobacco dependence. All tobacco users should be offered evidence-based care, without being screened for readiness as a precondition for receiving treatment. Opt-out care for tobacco dependence is warranted because changing defaults has been shown to change choices and outcomes for numerous health behaviors, and most tobacco users want to quit; there is little to no evidence supporting the utility of assessing readiness to quit, and an opt-out default is more ethical.
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA; Kansas University Cancer Center, Kansas City, Kansas, USA.
authors.forename: Kimber P
authors.initials: KP
authors.lastname: Richter
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
mesh_terms: D002755:Choice Behavior / Q000941:ethics*; D003657:Decision Making; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D006801:Humans; D009042:Motivation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D059039:Standard of Care; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*
keywords: Access; evaluation; evidence-based practice; harm reduction; health care quality; health services; motivation; practice guidelines; smoking cessation; tobacco use disorder