Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
Clin Infect Dis. 2012 Sep;55(6):837-43. doi: 10.1093/cid/cis520. Epub 2012 Jun 5.
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.
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.
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.
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.
医疗服务提供者必须为前往黄热病（YF）流行地区的旅行者提供疫苗接种咨询，但有关疾病和疫苗严重不良反应（SAE）的风险估计可能并不准确。风险信息以及患者对参与疫苗决策的请求对提供者建议的影响尚不清楚。
在向疫苗提供者提供有关 YF 疾病风险与疫苗 SAE 风险的信息之前和之后，针对 4 个患者情景对疫苗提供者进行了决策调查。通过 χ(2)检验并采用.05 的显著性水平比较参与者的理论态度与患者希望共享疫苗决策时的实际情景反应。
46%的受访者对孕妇、73%的对免疫抑制男性和 49%的对 8 个月大婴儿做出了适当的初始 YF 疫苗接种决定。在收到特定情景的信息后，分别有 20%、54%和 23%的初始错误回应的受访者改变为更适当的决定。31%的参与者做出了始终一致的适当决定。在做出≥1 个错误决定的参与者中，有 35.7%在收到信息后没有做出任何决策改变。在可以选择拒绝或接种疫苗的情景中，有 19%的受访者拒绝了患者的疫苗接种请求。
有针对性的信息是必要的，但不足以改变疫苗接种管理决策过程。提供者需要接受额外的教育，以便能够应用证据、克服认知决策错误并使患者参与疫苗决策。
