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A Systematic Review and Meta-Analysis of the Effectiveness of Process Interventions for Reducing Distress During
Anna Taddio1,2,3, Vibhuti Shah4,5, C Meghan McMurtry6,7,8
1Professor, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.
Background:
This systematic review was undertaken as part of a 10-year update to our 2015 clinical practice guideline about reducing distress during vaccination. Altogether, 4 clinical questions were included evaluating the effectiveness of process (ie, education and implementation) interventions targeting: (1) clinicians, (2) support persons, (3) vaccine recipients, and (4) multiple user groups (ie, multicomponent/complex interventions).
Methods:
The protocol was registered. Randomized and quasi-randomized controlled trials were identified from a search strategy that included 5 databases: MEDLINE, EMBASE, APA PsycINFO, CINAHL, and ProQuest Dissertations. Critical outcomes included distress (self-reported and observer-reported), along with participants' knowledge and use of distress-mitigating interventions. Data were extracted and pooled using a random effects model. Quantitative data were summarized using standardized mean differences (SMDs) and 95% CI. Summary statements were developed based on the certainty of evidence and magnitude of effect.
Results:
Seventeen unique studies were included. Across the evidence base, the certainty of evidence ranged from high to low and the magnitude of effect exceeded the minimum threshold (SMD=0.2) across available critical outcomes. The results indicate that educating clinicians may increase the use of distress-reducing interventions (SMD=0.66, low certainty). Support person education likely reduces distress in vaccine recipients slightly (SMD=-0.30; moderate certainty), may increase the use of distress-reducing interventions (SMD=0.67; low certainty), and likely increases support person knowledge about distress-reducing interventions slightly (SMD=0.25; moderate certainty). Educating vaccine recipients may result in a large reduction in distress (SMD=-0.80; low certainty). Multicomponent interventions reduce distress slightly (SMD=-0.21; high certainty) and likely increase the use of distress-reducing interventions (SMD=0.60; moderate certainty).
Conclusions:
Educating and implementing interventions across relevant user groups involved in vaccinations, including clinicians, support persons, vaccine recipients, and multicomponent interventions, is recommended to reduce distress during vaccine injections.
