Increasing colonoscopies? A psychological perspective on opting in versus opting out

A growing strategy to enhancing healthy decision making is to modify behavioral options to an "opt out" (i.e., if you do not want to participate, you must act) as opposed to an "opt in" (i.e., if you want to participate, you must act) default system (Choi, Laibson, Madrian, & Metrick). The current study, however, proposes that this growing trend may not always be strategic and examines these default systems in colonoscopy appointment show-up rates.

Participants in an opt-in condition received instructions to call and schedule their colonoscopy appointment, whereas participants in an opt-out condition were mailed the date and time of an already scheduled appointment. We then assessed colonoscopy appointment show-up rates.

As predicted, results revealed significant decrements in the show-up rates of those in the opt-out (63%) versus opt-in condition, 85%; χ² (1) = 5.51, p = .02. Furthermore, when looking at patients who confirmed their appointment in both conditions, only 3% of opt-in (vs. 21% of opt-outpatients) no-showed, χ² (1) = 4.51, p = .03.

Although modifying the default to an opt-out system has been shown to be effective in some health care procedures, the current results reveal this system is not always effective in producing the healthiest medical behaviors. Our research, then, suggests that opt-out paradigms are not an overall panacea for increasing participation in preventive health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).