2023
DOI: 10.1001/jamainternmed.2023.4321
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Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening

Leah M. Marcotte,
Stefanie Deeds,
Chelle Wheat
et al.

Abstract: ImportanceOptimal strategies for population-based outreach for breast cancer screening remain unknown.ObjectiveTo evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy.Design, Setting, and ParticipantsThis pragmatic randomized clinical trial was conducted from April 2022 to January 2023 at a single Veterans Affairs (VA) medical center. Participants were female veterans aged 45 to 75 years who were eligib… Show more

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Cited by 9 publications
(11 citation statements)
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“…In Reply We appreciate the interest of Joyce et al in our study . The primary concern raised by their letter is that we have inaccurately used the definitions of opt-out and opt-in methods in our trial and therefore have undervalued the role that opt-out procedures can have in clinical trials including enrollment.…”
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confidence: 93%
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“…In Reply We appreciate the interest of Joyce et al in our study . The primary concern raised by their letter is that we have inaccurately used the definitions of opt-out and opt-in methods in our trial and therefore have undervalued the role that opt-out procedures can have in clinical trials including enrollment.…”
mentioning
confidence: 93%
“…The primary concern raised by their letter is that we have inaccurately used the definitions of opt-out and opt-in methods in our trial and therefore have undervalued the role that opt-out procedures can have in clinical trials including enrollment. We conducted a pragmatic quality improvement trial to test 2 different population-based outreach strategies for breast cancer screening (BCS) in the VA Puget Sound Health Care System . This study was carried out as a collaboration between research and clinical teams in a learning health system model .…”
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confidence: 99%
“…To conclude, Marcotte et al present valid concerns, but they are rooted in study design and not inherent to true opt-out processes. The opt-out option remains an important tool for patient recruitment; clarity in definitions and parameters is essential.…”
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confidence: 99%
“…These findings contrast with most published literature and may have resulted from the heterogeneous application of these terminologies . To enable meaningful use, we propose 2 fundamental changes: first, restrict these terminologies to the potential approach, not the actual enrollment or conduct of services; and second, establish definitions for these colloquial terms in clinical and research practices.…”
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confidence: 99%
“…In the Original Investigation titled “Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening: A Randomized Clinical Trial,” published online September 11, 2023, and in the November 2023 print issue, in the Abstract Results, the number (percentage) of patients with completed or scheduled mammography in the intention-to-treat analysis was switched to 106 (24.0%) in the opt-out group and 84 (19.0%) in the opt-in group. Also, in the Figure, 388 (not 338) patients in the opt-in group received outreach, 53 (not 103) did not receive outreach, and 388 (not 338) were included in the restricted analysis.…”
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confidence: 99%