The purpose of this study is to assess, prospectively, the effect on flu vaccination rates of a pre-visit questionnaire that asks patients to indicate their preferences for a flu shot. Responses to the questionnaire will also be shown to clinicians via additional text in an existing flu shot alert. The investigators hypothesize that the pre-visit questionnaire will lead to increased flu vaccination compared with standard practices.

The CDC (Centers for Disease Control and Prevention) recommends a flu vaccination to everyone aged 6+ months, with rare exception; almost anyone can benefit from the vaccine, which can reduce illnesses, missed work, hospitalizations, and death. One barrier to vaccination is a lack of "cues to action," which could be overcome by asking patients for a pre-visit commitment to get a flu shot and additional reminders for the clinician to act on this commitment.

Eligible patients will be randomized to either receive or not receive a one-item, pre-visit questionnaire about the flu shot (that will show responses to clinicians in an existing flu shot alert).

Patient Inclusion Criteria:

• On a list of active Geisinger patients (all patients on this list attended at least one primary care appointment at Geisinger between 10/1/2008 and 4/13/2022, and either had a Geisinger primary care provider assigned as of April 2022, or were in the Electronic Health Record [EHR] since at least September 2021 and had at least one encounter in 2020-2022)
• Has an upcoming flu shot-eligible outpatient visit with a provider
• Has activated Geisinger's patient portal
• Has not yet received a flu vaccine at the time the questionnaire became available, according to the EHR

Clinician Inclusion Criteria

• Any Geisinger clinician who sees patient-participants in our study for a flu shot-eligible outpatient visit

Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings.

By the paper's online publication date. Data will remain available for as long as the Open Science Framework hosts it.

The data on the Open Science Framework will be open to anyone requesting that information.

Patient-participants will not be explicitly told about the different arms, although clinician-participants will see the different arms and may notice these differences.