Healthcare professionals’ perspectives on implementing opt-out smoking cessation in perioperative and cancer care in the Netherlands: A qualitative interview study

INTRODUCTIONSmokers face increased risks of complications and mortality after surgery or cancer treatment.Smoking cessation care is usually offered in an opt-in manner, meaning that patients must actively choose to receive support.Consequently, support may primarily reach patients who are already highly motivated to quit.Combined with healthcare professionals' barriers, such as limited time or training, this may reduce delivery of cessation care.An opt-out approach, in which healthcare professionals routinely refer all patients who smoke to smoking cessation support as part of standard care unless they decline, may increase uptake of cessation support.This study explored healthcare professionals' perspectives on implementing opt-out smoking cessation care during the perioperative and cancer treatment phases.METHODS A qualitative study was conducted in the Netherlands using semistructured interviews with healthcare professionals from different hospitals between March and April 2025.Eligible participants were healthcare professionals employed in a Dutch general, academic, or specialist oncology hospital and involved in perioperative or cancer care.The interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis approach combining deductive and inductive coding.RESULTS Thirteen healthcare professionals from ten Dutch hospitals were interviewed.Two overarching themes were identified: 1) perceived effects of the opt-out approach on patient participation and the doctor-patient relationship; and 2) facilitators and barriers to implementation.Participants anticipated increased uptake of smoking cessation support by lowering participation barriers.Facilitators included standardized referral pathways and routine integration.Potential challenges included limited time, staff constraints, patient motivation, and autonomy concerns.CONCLUSIONS Healthcare professionals generally perceived the opt-out approach as an acceptable and potentially feasible strategy to improve access to smoking cessation support.Successful implementation is likely to require adequate organizational support and clear referral pathways.Further research is needed to identify optimal implementation strategies and evaluate impacts on referral rates, uptake of support, and patient outcomes.