Use Shared Decision-Making Model In Deciding On AstraZeneca Jab — Prof Dr Ng Chirk Jenn, Dr Lee Yew Kong & Dr Adina Abdullah

Members of the public should ask more questions about the actual benefits and risks of the vaccine, and think carefully about what is important before making a decision.

Last Sunday was a busy day for most health care workers. It was not due to the substantial increase in newly diagnosed Covid-19 cases, nor was it due to hospitals scrambling to create more ICU beds.

It was the day that the AstraZeneca (AZ) vaccine website opened for registration. Health care workers all over the country were receiving messages from friends and family asking if they should register as they did not want to miss out on the opportunity.

Four days prior, the Minister of Science, Technology and Innovation, Khairy Jamaluddin, had announced the removal of the AZ vaccine from the National Covid-19 Immunisation Programme (PICK) as decided by the Covid-19 Immunisation Task Force (CITF).

The plan was to offer the AZ vaccine through a separate registration channel to adults aged 18 years and above who were willing to have it. The vaccine was proven effective in clinical trials and recent real-world data reported by the Korea Disease Control and Prevention Agency (KDCA) found that the AZ vaccine to be 86 per cent effective in preventing Covid-19 infection at least two weeks after the first dose.

However, recent reports of potential fatal thrombotic side effects associated with the vaccine had made it an outcast in the Covid-19 vaccine landscape. Several countries such as Denmark, Norway and Hong Kong deemed the side effects significant enough to remove the vaccine from their immunisation programmes. 

However, in Malaysia, the response from the public to the vaccine registration was overwhelming; all 268,800 appointment slots offered at four vaccination centres were taken up within three hours.

However, there are concerns among the healthcare providers whether the decision made by the public was fully informed, or rather the rush to register for the vaccination was fuelled by their desire not to be left out.

While the current evidence on Covid-19 vaccination shows that benefits far outweigh the risks, how these benefits and risks are communicated to the public vary considerably and this might have influenced how the public make decisions.  

Novel laureate Daniel Kahneman mentioned two pathways of decision making: One is fast and tuned for quick, intuitive decisions while the other is slower and more deliberate.

As with the registration for the AZ vaccine, some may have made the vaccine decision quickly to avoid missing out, while others who had access to health care workers may have taken time to explore the option more carefully. The latter process mirrors the shared decision-making model. 

In health care, a shared decision-making model is often recommended when making decisions which is neither right nor wrong. Using this model, health care providers provide medical information, elicit the patient’s preferences, and make a decision together with (not for) the patient.

Research have shown that using this approach helps people to be knowledgeable and less conflicted with the decision they made. Decision support tools known as patient decision aids help to facilitate this process.

A patient decision aid is a tool that makes explicit the decision that needs to be made, provides information about the options and outcomes, and clarifies what is important to a person (values). It complements rather than replaces discussions with health care providers. 

For the AZ vaccine, an online patient decision aid and explanation video on whether to go for the vaccine has been developed from the ‘Ask Share Know’ (ASK) NHMRC Centre of Research Excellence in Australia:

For most part, the information in this patient decision aid is more relevant to the Australian setting, but it highlights important information that needs to be considered by those registering for the AZ vaccine. This includes: 

  • What is involved in getting the vaccine? 
  • What are other vaccine options? 
  • Who should NOT have the AZ vaccine? 
  • What are the potential benefits and side effects of the AZ vaccine? and 
  • What is the most important to you? 

The last question is meant to elicit your values and preferences, what outcome is important for you an individual. As previously mentioned, shared decision-making should ideally be conducted with a health care provider.

However, with current stress on the health care system, the public should use few aspects of the shared decision-making model to help them make the right decision.  

We would urge all members of the public to ask more questions about the actual benefits and risks of the vaccine, and think carefully about what is important to yourself before making a decision.

If in doubt, discuss this decision with your doctor; if this is not possible, use a decision aid to guide you in making an informed decision.

Decide based on facts, not gut feelings or from fear of missing out. 

Prof Dr Ng Chirk Jenn, Dr Lee Yew Kong and Dr Adina Abdullah are from the Faculty of Medicine, University of Malaya.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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