Shared decision making enhances adult influenza vaccination rates in outpatient care – a systematic review and meta-analysis

Linda Sanftenberg, Flora Kuehne, Charlotte Anraad, Caroline Jung-Sievers, Tobias Dreischulte, Jochen Gensichen

Keywords: vaccination, adults, influenza, shared decision making


Seasonal influenza leads to a considerable burden of disease worldwide while insufficient vaccination rates can be observed in several countries and populations. Shared decision-making (SDM) may address barriers to vaccination. The objective of this review was to assess the impact of SDM on influenza vaccination rates in adult patients in outpatient care.


We conducted a systematic literature search in MEDLINE, EMBASE, CENTRAL, PsycINFO, and ERIC in 2020. Only RCTs were included. Studies had to aim an uptake of influenza vaccination rates in adults and comprise a personal interaction between health care providers (HCPs) and patient. Three further aspects of the SDM process (patient activation, bi-directional exchange of information and bi-directional deliberation) were assessed. A meta-analysis was conducted for the effects of interventions on influenza vaccination rates.


We included 21 studies, with interventions including face-to-face sessions, telephone outreach, home visits, HCP trainings and supporting educational material. In 12 studies, interventions included all elements of a SDM process. A meta-analysis was conducted for 15 studies resulting in an OR of 1.96 (95% CI: 1.31 to 2.95) for influenza vaccination rates. Subgroup analyses suggested a higher effectiveness of interventions, which included all criteria of a SDM process, compared to interventions that focused only on patient activation. Sharing responsibilities to facilitate SDM among HCPs in a team was also very successful.


This study provides evidence that SDM is appropriate to increase adult vaccination rates for seasonal influenza. As the majority of adult patients is vaccinated in outpatient care, our findings are of relevance for HCPs and vaccination delivery service. Further research with detailed descriptions of SDM implementation modalities is necessary to understand which components of SDM are most effective. Trial Registration: PROSPERO: CRD42020175555