Decision support for immnization: A literature review and introduction to decision aids

Abstract

Purpose The aims of this study were: 1. to examine the effectiveness of decision support for immunization by a literature review and 2. to describe the web-based decision support instruments (decision aids) for immunization with the inclusion of the quality standards Methods Eligible studies using decision supports for immunization were retrieved with selected key words. Retrieved literature was analysed by whether the outcome (vaccination rate and quality of the decision) was improved by the support. The type and content of immunization-related decision aids, accessible on the Internet, were described. The recent movement of creating international quality standards as a basis for the development and evaluation of those decision aids was also presented. Results Literature review: The retrieved six studies were all conducted in developed countries outside Japan of which, four were Randomized Controlled Trial (RCT) to assess the effectiveness of the intervention. All RCTs included the outcome measurement of vaccination status (vaccination rate, action, or intention). However, the participants' vaccination status was the secondary outcome in most of the studies and the psychological indicators such as decision conflict, anxiety, satisfaction, and confidence were drawn as the primary outcome to measure the quality of the decision. Introduction to decision aids: The presented immunization-related decision aids were all developed in western countries and evaluated using the international quality standards (IPDAS checklist: the abbreviated version of International Patient Decision Aids Standards). Among six decision aids, only one instrument met all the checklist criteria. Conclusion Only a small number of studies were found regarding decision support for immunization, thus the impact of decision support is still limited. Further research is needed to elucidate the optimal timing of support, the effective support methods, and the appropriate outcome indicators for evaluation. The establishment of the international quality standards for decision aids is on-going movement. Those who develop and utilize decision aids need to do so in the light of the standards.