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Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening: A Randomized Clinical Trial.

Leah M Marcotte¹, Stefanie Deeds^1,2, Chelle Wheat³

¹Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle.

JAMA Internal Medicine

|September 11, 2023

Summary

An opt-out strategy for breast cancer screening outreach did not improve mammography completion rates compared to an opt-in approach. However, it significantly increased canceled referrals, potentially increasing healthcare staff workload.

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Area of Science:

Public Health
Preventive Medicine
Oncology

Background:

Optimal population-based outreach strategies for breast cancer screening are not well-established.
Effective strategies are crucial for early detection and improving patient outcomes.

Purpose of the Study:

To compare the effectiveness of an opt-out automatic mammography referral strategy versus an opt-in automated telephone message strategy for breast cancer screening.
To evaluate the impact of different outreach approaches on mammography completion and referral management.

Main Methods:

A pragmatic randomized clinical trial involving 883 female veterans aged 45-75 eligible for breast cancer screening.
Participants were randomized 1:1 to either an opt-out automatic mammography referral group or an opt-in automated telephone call group.
Primary outcome was completed mammography within 100 days; secondary outcomes included scheduled/completed mammography and canceled referrals.

Main Results:

No significant difference in completed mammography at 100 days between the opt-out (15.2%) and opt-in (14.9%) groups (P=.90) in intention-to-treat analysis.
A significantly higher rate of canceled mammography referrals was observed in the opt-out group (23.6%) compared to the opt-in group (5.4%) (P<.001).
A restricted analysis showed a statistically significant increase in completed or scheduled mammography in the opt-out group (26.3%) versus the opt-in group (19.3%) (P=.02).

Conclusions:

The opt-out breast cancer screening outreach approach did not significantly increase mammography completion compared to the opt-in method.
The opt-out strategy resulted in a substantially higher number of canceled referrals, potentially increasing administrative burden and healthcare staff workload.