Shared Decision Making Enhances Pneumococcal Vaccination Rates in Adult Patients in Outpatient Care

Insufficient vaccination rates against pneumococcal disease are a major problem in primary health care, especially in adult patients. Shared decision-making (SDM) may address major barriers to vaccination. The objective of this review was to assess the impact of SDM on pneumococcal vaccination rates in adult patients. We conducted a systematic literature search in MEDLINE, EMBASE, CENTRAL, PsycINFO, and ERIC. RCTs and cluster RCTs were included, if they aimed to enhance pneumococcal vaccination rates in adult patients and comprised a personal interaction between health care provider (HCP) and patient. Three further aspects of the SDM process (patient activation, bi-directional exchange of information and bi-directional deliberation) were assessed. A meta-analysis was conducted for the effects of interventions on vaccination rates. We identified eight studies meeting the inclusion criteria. The pooled effect size was OR (95% CI): 2.26 (1.60-3.18) comparing intervention and control groups. Our findings demonstrate the efficacy of interventions that enable a SDM process to enhance pneumococcal vaccination rates; although, the quality of evidence was low. In exploratory subgroup analyses, we concluded that an impersonal patient activation and an exchange of information facilitated by nurses are sufficient to increase vaccination rates against pneumococcal disease in adult patients. However, the deliberation of options between physicians and patients seemed to be more effective than deliberation of options between nurses and patients.