BACKGROUND-AIM:
Smokers are at a higher risk of complications and mortality after surgery or cancer treatment. However, healthcare professionals often experience barriers to discuss smoking, resulting in limited delivery of smoking cessation care. An opt-out method, in which patients are automatically referred to cessation support unless they explicitly decline, may help overcome these barriers. We aimed to explore 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 semi-structured interviews with healthcare professionals from various specialisms and hospitals. The interviews were audio recorded, transcribed verbatim, and thematically analysed.

RESULTS:
Thirteen healthcare professionals from ten hospitals were interviewed. None had experience with the opt-out method, and most worked in hospitals without structured smoking cessation care. Participants identified surgery and cancer treatment as potential teachable moments for smoking cessation, but noted that patient stress and information overload could limit motivation. Most supported the opt-out approach, anticipating increased patient enrolment, while emphasizing the need to maintain patient autonomy and a positive doctor–patient relationship. A key facilitator for implementation was the establishment of standardized referral processes, while limited time and resources were identified as significant barriers.

CONCLUSIONS:
The opt-out approach shows good potential. Its effective introduction may depend on the establishment of a structured and accessible smoking cessation care system. Further research is needed to explore how to implement this method and assess the feasibility and effectiveness in clinical practice.