Decision Support for Adults Considering COVID-19 Booster Vaccinations

Abstract

Purpose To develop and conduct preliminary testing of a decision support intervention to address the decisional needs of older adults considering COVID-19 booster vaccinations. Methods Multi-methods, guided by the Ottawa Decision Support Framework, were used. Study 1 identified decisional needs of Canadian adults who reported difficulty making COVID-19 vaccination decisions using data from two population-based cross-sectional surveys; Study 2 identified decisional needs of older adults considering COVID-19 booster vaccinations using a systematic review; Study 3 co-developed and iteratively tested a PtDA for older adults considering COVID-19 booster vaccinations. Findings In study 1, 490/1454 (33.7%) participants in Year 1 of the COVID-19 pandemic and 475/1718 (27.6%) in Year 2 identified COVID-19 vaccinations as the most difficult decision. Respectively, 22.7% and 26.3% participants had a clinically significant decisional conflict. Factors making vaccination decisions difficult were worry about choosing the ‘wrong’ option (45.5%, 32.0%), difficulty separating misinformation from scientific evidence (39.4%, 30.9%), and worry about getting COVID-19 (30.4%, 30.9%). For participants who made the vaccination decision, significant decision regret increased from 23.9% in Year 1 to 38.4% in Year 2. In study 2, ten studies of older adults considering booster vaccination identified decisional needs including uncertainty about the decision (e.g., 32.3% vaccine hesitancy), inadequate knowledge about effectiveness, safety, and eligibility for booster vaccinations, and lack of resources to support decision-making. In study 3, findings above were combined with evidence from clinical practice guidelines to co-develop a PtDA with researchers, a patient and a family caregiver. Three iterative rounds of testing were conducted with 14 older Canadians and 5 healthcare professionals. Participants reported the PtDA was acceptable and would help older Canadians prepare for making decisions about booster vaccinations. Conclusion During the COVID-19 pandemic, adults in Canada reported unmet decisional needs, including decisional conflict and decision regret about COVID-19 vaccination decisions. Unmet decisional needs were also identified from international literature. The PtDA was reported as useful for assisting older adults in Canada in making booster vaccination decisions. Further research could more rigorously evaluate the PtDA and determine ways to disseminate and implement it with people feeling hesitant about COVID-19 vaccinations.