Shared decision making enhances vaccination rates in adult patients in outpatient care – a systematic review and meta-analysis

Linda Sanftenberg, Flora Kuehne, Charlotte Anraad, Caroline Jung-Sievers, Tobias Dreischulte, Jochen Gensichen

Keywords: shared decision making; vaccination; influenza; pneumococcal disease; systematic review; adult

Insufficient vaccination rates in adults are a major problem in primary health care, leading to an international burden of disease. Shared decision-making (SDM) might address major barriers to vaccination.

Research questions:
The objective of this review was to assess the impact of SDM on adult vaccination rates in outpatient care.


We conducted a systematic literature search in MEDLINE, EMBASE, CENTRAL, PsycINFO, and ERIC on February 2nd, 2020. Only (clustered) RCTs were included. Studies had to aim an uptake of vaccination rates in adults and comprise 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. Trial Registration PROSPERO: CRD42020175555

We included 26 studies in our analysis. The pooled effect size was OR (95% CI): 2.26 (1.60–3.18) for pneumococcal vaccination and OR of 1.96 (95% CI: 1.31 to 2.95) for influenza vaccinaton rates. Subgroup analyses among influenza vaccination studies suggested a higher effectiveness if all criteria of a SDM process were considered, compared to interventions that focused only on patient activation. Sharing responsibilities among HCP teams increased also influenza vaccination rates. Concerning pneumococcal vaccinations, impersonal patient activation methods, the exchange of information facilitated by a non-physician HCP and a deliberation of options enabled by a physician were successful.

This systematic review and meta-analysis provide evidence that SDM processes can be an effective strategy to increase adult vaccination rates. With the majority of patients being vaccinated in outpatient care, especially in primary care practices, our findings are of direct relevance for HCP and vaccination service delivery. Further studies with more detailed descriptions of SDM implementation modalities is necessary to understand which components of SDM are most effective.

Points for discussion: