JHQ 307: Quality Improvement Interventions to Enhance Vaccination Rates in Cancer Patients: A Systematic Review-JHQ 307 Article

JHQ 307 Article

Pdf Summary

This systematic review examined quality improvement (QI) interventions designed to increase vaccine uptake among cancer patients, who are at elevated risk of severe infection due to immunosuppression from malignancy and treatment. Despite guideline recommendations for vaccines such as influenza and pneumococcal—ideally given before immunosuppressive therapy—vaccination rates in oncology populations remain low.<br /><br />Using PRISMA methods, the authors searched PubMed and the Cochrane Library for studies published through December 31, 2022. Thirteen studies (2014–2022) met inclusion criteria, covering both adult and pediatric oncology populations across outpatient clinics, inpatient units, infusion centers, and tertiary cancer centers. Seven studies focused on influenza vaccination, five on pneumococcal vaccination, and one on both. Most studies were before–after designs with heterogeneous methods, preventing meta-analysis; study quality was mostly rated good.<br /><br />All included studies reported improved vaccine uptake after implementing QI interventions. Twelve studies used multi-component approaches. Common strategies included: educating patients and families (handouts, brochures, online education, addressing misconceptions); systematically identifying vaccine-eligible patients before visits (EMR lists, previsit planning, chart review); prompting and reminding providers (best-practice EMR alerts, emails, visual cues such as wristbands or chart reminders); creating streamlined vaccine ordering processes (order sets, preprinted prescriptions); staff education on vaccine guidelines; assigning designated personnel (nurse-led programs, APRN oversight); and increasing on-site vaccine availability.<br /><br />Although no single intervention could be isolated as definitively superior, the review suggests provider reminders and previsit eligibility checks have the strongest and most consistent support across settings and populations. Reported barriers to achieving optimal rates included patient/family refusal and limited opportunities to vaccinate due to infrequent visits. The authors conclude that QI frameworks—especially iterative Plan-Do-Study-Act cycles—can meaningfully improve influenza and pneumococcal vaccination in cancer care, and future work should address implementation barriers and expand to other vaccines.

Keywords

systematic review

quality improvement interventions

vaccine uptake

oncology patients

immunosuppression

influenza vaccination

pneumococcal vaccination

EMR alerts and reminders

previsit eligibility screening

Plan-Do-Study-Act cycles