Vaccine hesitancy is a very challenging, and often tiring topic, for clinicians to address. Join Dr. Rachel Caskey in an engaging clinician-patient dialogue as she uses a dynamic and presumptive approach to overcome common vaccination challenges. What communication pearl will you use with your patients?
Improving Clinician and Patient Communication about Vaccines
Improving Clinician and Patient Communication about Vaccines
Hello, I'm Dr. Rachel Caskey, and I'd like to welcome you to our Patient-Clinician Connection on vaccine hesitancy. I'm an associate professor of internal medicine and pediatrics at the University of Illinois at Chicago.
Vaccine hesitancy can be a very challenging and tiring topic for clinicians to address. Understandably, both clinicians and patients are suffering from vaccine recommendation fatigue. General tips for addressing vaccine hesitancy include giving a very clear recommendation for vaccination, reassurance about our robust safety monitoring system in the US, and using personal stories rather than data and statistics to encourage vaccination. But most importantly, don't take the patient's decision personally.
I will be illustrating strategies to achieve these goals through 3 vignettes. Let's get started.
Today Miss Gonzalez is in my office and her son, Frank, is in the exam room. Miss Gonzalez and I are discussing the 3 recommended vaccinations for Frank. Frank is an 11-year-old and her only child. This family has been coming to my practice for 5 years. Frank's visit has been uneventful. He is a healthy 11-year-old who is growing and developing appropriately. We are ending the visit with a discussion about the 3 adolescent vaccines recommended for Frank.
In the following vignette, I will be using the presumptive approach to recommend these vaccines.
Miss Gonzalez, it was great to see you and Frank today. As I mentioned in the room, he is growing and developing very well.
That's great to hear.
So he is due for 3 routine vaccines today: Tdap, which is tetanus, diphtheria, and pertussis; human papilloma virus; and the meningitis vaccine. We can get those started as soon as we're done talking.
Actually, I'm not sure if I want to get Frank vaccinated today.
What are your concerns?
Well, with everything in the news lately about the vaccines, I'm just unsure if it's safe. I know Frank got vaccinated when he was a baby, but I'm just wondering if I should even do it anymore.
The safety of vaccines is a common concern, especially if a vaccine is believed to be new or new to the patient. Common safety concerns include number of vaccines being administered, additives or preservatives in a vaccine, or potential adverse side effects. There are multiple vaccine safety monitoring efforts in the US, and most patients are not aware that vaccines are so closely monitored.
For example, vaccines are monitored both pre- and post-licensure by the manufacturers. The Vaccine Adverse Event Reporting System, or commonly referred to as VAERS, is a publicly available site to report potential adverse side effects from a vaccine. All healthcare providers are mandatory reporters for the VAERS system. And finally, the Vaccine Safety Datalink, which is run by the CDC, monitors electronic health information from multiple large medical centers to find any evidence for vaccine adverse side effects.
Let's return to our discussion with Miss Gonzalez.
I understand your concerns about safety. In fact, many parents share those concerns. I want to assure you vaccines are monitored for safety continuously.
For example, before a vaccine is even available for use, it's checked for safety. And then after it's available for use, it is continuously monitored by multiple different methods in the US for safety. Now, if any serious side effects are found, vaccines are taken off the market immediately.
We have over 50 years of experience to show us that getting a disease is actually much more dangerous than getting the vaccine itself. So vaccines are more safely monitored than any other pharmaceutical product, medication, or device that we use in healthcare. And on a personal note, Miss Gonzalez, I want to tell you all 3 of my children have received these 3 vaccines.
Dr. Caskey, I understand the vaccines you recommend are completely considered safe. And I do trust your opinion, but…
What's bothering you?
Yes, so 3 vaccines during 1 visit seems too much for me for the immune system. Can we just take 1 today, and then we'll do the rest on a different date? I mean, what difference does it make? None of my friends have ever heard of any of these diseases. Even if Frank gets sick, wouldn't him getting sick protect him just as the vaccine would do? I mean, honestly, it's just there's so much information floating around there that I just don't know anymore.
There is a continuum of parental acceptance of vaccines from vaccine rejector at one end of the spectrum to vaccine acceptor at the other, the vaccine-hesitant group sitting in the middle. It's important to remember that the vaccine rejector group is actually by far the smallest group along this continuum, though it doesn't always feel that way.
Research has found that the majority of vaccine-hesitant parents are really on the fence, so to speak. They are not completely opposed to vaccination. In fact, many have accepted vaccination in the past. They simply have questions, need more information, or need reassurance.
Vaccines do not overwhelm the immune system; disseminated meningococcal does. Our immune system is constantly working to protect us against multiple simultaneous infections. Vaccination is not unnatural. Vaccines stimulate the immune system to produce protection, not unlike natural infection. The difference is that an individual does not have to acquire the disease and the potential side effects from the disease, some of which could be permanent or long-term, to develop that protection. While immunity acquired from natural infection might seem to make sense to some, the risks are much higher. With natural infection, complications could occur, some of which could be long-lasting or life-threatening.
Though some of the infant and childhood vaccine-preventable diseases are now eradicated in the US, that is not the case for all vaccine-preventable infections; outbreaks still occur. In addition, some vaccine-preventable infections are still prevalent, such as HPV.
Let's return to our discussion.
Miss Gonzalez, those questions about vaccines are important. I'd be happy to share my thoughts, if that's okay?
Thank you. Yes.
Let's take them in order. So first, the number of vaccines. Frank is due for 3 routine vaccines today. So our immune system is designed to constantly fight germs. Our immune system is always fighting viruses and bacteria that are on us or around us. So these vaccines will not overwhelm Frank’s immune system. In fact, his immune system is constantly being challenged, and that's normal. In terms of timing, the timing of the vaccines is to maximize the protection they provide.
Thank you, Dr. Caskey. I do trust your recommendations. I thought that vaccines were scheduled more randomly. I didn't know their timing was important.
I'm glad to hear that. Now you also mentioned you consider the diseases these vaccines prevent to be uncommon. And while that's true for some infections that we vaccinate against, that's not true for all infections. In fact, some infections are still common, for example, human papillomavirus. Also, outbreaks can occur. And some infections such as pertussis, which is whooping cough, or measles can occur when an outbreak happens, particularly when people are not vaccinated. These vaccines will prevent Frank from getting those infections.
Okay, that makes a lot of sense. Last question.
So, for Frank, if we get him vaccinated, will he get an infection off the vaccine? The reason I'm asking is because I took the flu vaccine a while back, a few times, and I've noticed that every time I took the vaccine, I got sick right after.
I can't tell you how many times I hear that. And I want to assure you, it is impossible to get the infection from the vaccine. So these vaccines, like most, including the flu vaccine, don't contain the virus or bacteria. They contain pieces or proteins of it. And it's those pieces or proteins that trigger the immune system to make antibodies to protect you. They do not contain the entire germ. So it is impossible for Frank to become sick from getting the vaccine.
Okay, thank you so much for taking the time answering my questions and addressing my concerns. I feel better. And I think I'm ready to go ahead and move forward with the 3 shots, the 3 vaccines.
In our Patient-Clinician Connection vignette, I tried to model conversations that are used to overcome vaccine hesitancy with a parent of an adolescent child. There are many reasons for vaccine hesitancy, including those that are from the parent, patient, or are very vaccine-specific. Not all factors could be addressed in this vignette. However, many of the discussion points can be used regardless of the age of the patient or the vaccine being discussed.
When facing a vaccine-hesitant patient or family member, remember the following recommendations: always give a clear and strong recommendation; use a presumptive approach. Vaccines are a medical recommendation. Don't ask if someone would like one; recommend the vaccine. When concerns are brought up, affirm the patient's concerns and address the concerns and misconceptions. Be honest about side effects and risks but focus on the very robust safety monitoring system in the US. If you're comfortable, use personal stories that you feel may develop trust. And finally, keep the conversation going. This can take time. It is not uncommon that you may have to have a discussion about a vaccine more than once for a patient or family member to feel comfortable.
Today's vignettes addressed vaccine hesitancy during a childhood medical encounter. Certainly, vaccine hesitancy can extend across all ages. There can be hesitancy for childhood vaccines and adult vaccines. I think it is very likely that the model presented in these vignettes can be adapted to address vaccine hesitancy among any age group or with any vaccine.
Thank you for joining me for our Patient-Clinician Connection vignettes on vaccine hesitancy.
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Rachel N. Caskey, MD, MAPP
Associate Professor of Internal Medicine and Pediatrics
University of Illinois at Chicago
University of Illinois at Chicago
- Cindy Davidson has nothing to disclose.
- Barry Fiedel, PhD, has nothing to disclose.
- Nick Lombardi has no relevant relationships to report.
- Jay Runyon has nothing to disclose.
- Anna Trentini has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Counter common parent/patient responses along the continuum of vaccine hesitancy
- Devise communication strategies to use when having conversations with vaccine-hesitant parents/patients
This activity is designed to meet the educational needs of primary care physicians, pediatricians, nurse practitioners, physician assistants, nurses, and all healthcare professionals who are interested in vaccines.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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This activity is supported by an independent educational grant from Merck.
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