Patient choice in opt-in, active choice, and opt-out HIV screening: an RCT

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.h6895 (Published 19 January 2016)

What is already known on this topic

  • Patients’ preferences are a hallmark of patient centered care, but little is known about how wording of offers of testing can influence perceived preferences

  • Opt-in and opt-out HIV testing have not been compared in a randomized controlled setting

  • US guidelines endorse opt-out HIV testing, and Europe has seen a trend toward this testing scheme

What this study adds

  • Opt-in and opt-out defaults had statistically and clinically significant effects on the likelihood of patients accepting tests

  • Patients reporting risk factors were more likely to accept testing in each testing regimen than were patients reporting no risk factors

  • Active choice is a distinct test regimen, with test acceptance patterns that may best approximate patients’ true preferences