It's time to change the default for tobacco treatment
It's time to change the default for tobacco treatment
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DOI：
10.1111/add.12734
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发表时间：
2015-03-01
期刊：
影响因子：
6
通讯作者：
Ellerbeck, Edward F.
中科院分区：
文献类型：
--
作者：
Richter, Kimber P.;Ellerbeck, Edward F.
世界卫生组织估计，本世纪将有10亿人死于与烟草有关的疾病。然而，大多数医疗保健提供者未能治疗烟草依赖。这可能在一定程度上归因于待遇违约。许多国家的指导方针建议卫生保健提供者：(I)询问患者是否准备好戒烟；以及(Ii)只向那些声称准备戒烟的人提供治疗。对于其他健康状况，如糖尿病、高血压、哮喘，甚至药物滥用，治疗指南指导卫生保健提供者确定健康状况并启动循证治疗。与任何医疗护理一样，患者可以自由地拒绝接受治疗，他们可以选择不接受治疗。如果患者什么都不做，他们将得到治疗。然而，对于烟草使用者来说，治疗的缺省往往是他们不得不选择接受治疗。这极大地限制了烟草治疗的范围，因为在任何给定的遭遇中，少数烟草使用者都会说他们准备戒烟。因此，很少有人能得到治疗。现在是时候改变对烟草依赖的默认治疗了。应向所有烟草使用者提供循证护理，而不是将筛查是否准备就绪作为接受治疗的先决条件。对烟草依赖的选择戒烟护理是合理的，因为改变默认设置已被证明改变了许多健康行为的选择和结果，而且大多数烟草使用者想要戒烟；几乎没有证据支持评估戒烟准备情况的效用，而选择退出默认设置更符合道德。
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 conditionsdiabetes, hypertension, asthma and even substance abusetreatment guidelines direct health-care providers to identify the health condition and initiate evidence-based treatment. As with any medical care, patients are free to declinethey 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.