Vaccine administration decision making: the case of yellow fever vaccine.
BACKGROUND
Providers must counsel travelers to yellow fever (YF)-endemic areas, although risk estimates of disease and vaccine serious adverse events (SAEs) may be imprecise. The impact of risk information and patients' requests for participation in vaccine decisions on providers' recommendations is unknown.


METHODS
Vaccine providers were surveyed regarding decisions for 4 patient scenarios before and after being presented information about risk of YF disease vs vaccine SAEs. Participants' theoretical attitudes were compared with actual responses to scenarios in which patients wanted to share vaccine decisions. Analyses were done by using χ(2) tests with significance level of .05.


RESULTS
Forty-six percent of respondents made appropriate initial YF vaccine administration decisions for a pregnant woman, 73% for an immunosuppressed man, and 49% for an 8-month-old infant. After receiving scenario-specific information, 20%, 54%, and 23% of respondents respectively who initially responded incorrectly changed to a more appropriate decision. Thirty-one percent of participants made consistently appropriate decisions. Among participants who made ≥1 incorrect decision, 35.7% made no decision changes after receiving information. In the scenario in which either a decision to withhold or to administer vaccine was acceptable, 19% of respondents refused a patient's request for vaccine.


CONCLUSIONS
Targeted information is necessary but insufficient to change the process of vaccine administration decision making. Providers need additional education to enable them to apply evidence, overcome cognitive decision-making errors, and involve patients in vaccine decisions.
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA. blown@mah.harvard.edu
Beth A
BA
Lown
Lin H
LH
Chen
Mary E
ME
Wilson
Emily
E
Sisson
Mark
M
Gershman
Emad
E
Yanni
Emily S
ES
Jentes
Natasha S
NS
Hochberg
Davidson H
DH
Hamer
Elizabeth D
ED
Barnett
D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011247:Pregnancy; D014195:Travel; D057236:Travel Medicine / Q000379:methods*; D015004:Yellow Fever / Q000517:prevention & control*; D022341:Yellow Fever Vaccine / Q000008:administration & dosage* / Q000009:adverse effects*
D022341:Yellow Fever Vaccine