Shared Clinical Decision-Making Recommendations for Adult Immunization: What Do Physicians Think?

Area of Science:

• Immunization Practices
• Public Health Policy
• Primary Care Medicine

Background:

• The Advisory Committee on Immunization Practices (ACIP) introduced "shared clinical decision-making" (SDM) in 2019 for adult vaccine recommendations.
• This shift aims to enhance patient involvement in vaccination choices.

Purpose of the Study:

• To evaluate general internal medicine physicians' (GIMs) and family physicians' (FPs) attitudes, experiences, and knowledge regarding ACIP SDM recommendations.
• To assess how SDM is integrated into vaccine forecasting software and identify factors associated with implementation challenges.

Main Methods:

• A national survey of GIMs and FPs was conducted between October 2019 and January 2020.
• Data were collected via mail or internet, using Likert scales, true/false, and categorical responses, followed by multivariable modeling.

Main Results:

• A majority of physicians (90-95%) found SDM more time-consuming than routine recommendations and desired specific talking points.
• While 75-81% supported SDM for certain vaccines, 64-76% agreed it caused confusion; only 41-43% knew about insurance coverage.
• Forecasting software inconsistently displayed SDM recommendations, and GIMs and female physicians were more likely to be unsure how to implement SDM.

Conclusions:

• Shared clinical decision-making (SDM) for adult vaccinations presents implementation challenges in primary care settings.
• Physicians require enhanced decision-making support tools and patient-facing resources for effective SDM adoption.
• Addressing physician concerns about time, confusion, and software integration is essential for successful SDM implementation.