O'Connor A M, Pennie R A, Dales R E
School of Nursing, University of Ottawa, Ontario, Canada.
J Clin Epidemiol. 1996 Nov;49(11):1271-6. doi: 10.1016/s0895-4356(96)00177-1.
To examine the effects of using positive or negative frames to describe influenza vaccine benefits and side effects on patients' expectations, decisions, decisional conflict, and reported side effects.
292 previously unimmunized patients with chronic respiratory or cardiac disease were randomly assigned to receive benefit/risk information that was framed: (1) positively as the percentage who remain free of influenza and have no vaccine side effects, or (2) negatively as the percentage who acquire influenza and have vaccine side effects. Questionnaires elicited expectations, decisions, and decisional conflict. Vaccines were telephoned 3 days later for a self-report of local and systemic side effects and work absenteeism.
Both groups had similar immunization rates and decisional conflict scores. The positive frame group had lower and more realistic expectations of vaccine side effects, fewer systemic side effects, and less work absenteeism (p < 0.05).
In contrast to previous studies of health care workers, framing did not influence patients' decisions, possibly due to the patients' awareness of their higher risk of influenza complications and greater desire to follow recommendations. The common practice of using negative frames when describing probabilities of side effects may need to be reexamined, considering its deleterious influence on self-reported side effects and work absenteeism.
研究使用积极或消极框架描述流感疫苗的益处和副作用对患者期望、决策、决策冲突及报告的副作用的影响。
将292名既往未接种过疫苗的慢性呼吸道或心脏病患者随机分组，使其接收以下框架表述的益处/风险信息：（1）积极框架，即未感染流感且无疫苗副作用的人群百分比；（2）消极框架，即感染流感且有疫苗副作用的人群百分比。通过问卷调查获取期望、决策及决策冲突情况。3天后通过电话询问疫苗接种者关于局部和全身副作用及旷工情况的自我报告。
两组的免疫接种率和决策冲突得分相似。积极框架组对疫苗副作用的期望更低且更符合实际，全身副作用更少，旷工情况也更少（p<0.05）。
与之前针对医护人员的研究不同，框架表述并未影响患者的决策，这可能是由于患者意识到自身患流感并发症的风险更高，且更愿意遵循建议。考虑到消极框架对自我报告的副作用和旷工情况的有害影响，在描述副作用概率时使用消极框架的常见做法可能需要重新审视。
