How to Talk With Patients

Approaching the topic of vaccinations with patients can be a challenging one. The CDC has suggested “specific proven strategies to increase vaccination coverage rates,” however, a more individualized approach may be necessary.11 Currently, “caretakers should be advised about the risks and benefits of vaccination in a standard manner, using Vaccine Information Statements (VIS) produced by the CDC.”11 Any advice beyond these statements is left to the healthcare provider.

Undoubtedly, the forefront of the recent conversation about the risks and benefits of vaccinations has mainly involved younger patients. Increasingly, parents are coming to pediatricians for routine visits and requesting that vaccinations not be given. Media coverage of the perceived link between autism and vaccinations, compounded by support from celebrities and interest groups, has heightened the communication barrier between healthcare providers and their patients.

Parents can also refuse vaccinations for their children for other reasons, which can be classified into 4 broad categories: safety concerns, religious reasons, personal believes or philosophical reasons, and a desire to obtain more information from healthcare providers.12 An individualized approach to each patient’s concerns is, with certainty, the best way to ensure efficiency of ongoing care.


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There are a number of factors involved in a patient’s care that differ based on the age, background, and knowledge of the patient being vaccinated. Ongoing and open communication is crucial. Simply agreeing to withhold vaccinations without asking “why?” will perpetuate and worsen the outbreak of disease.                                                                  

Many parents refuse vaccinations for their children because of a perceived lack of necessity. The parent may believe that the disease is rare or eradicated, so their child would be unnecessarily exposed to a foreign material if they consent to vaccination. Explaining that vaccinations are not only to protect the patient but also to protect the population is an efficient approach to this situation. If a parent refuses vaccination for their child, that child opens himself or herself up to exposure to numerous diseases that can then be spread to other non-vaccinated children. Ultimately, it is a “relatively uncontroversial principle that it is wrong to harm others by transmitting a contagious illness that they were not liable to incur.”13 

Other parents may refuse vaccinations on religious or cultural grounds. Delving deeper into the reasoning behind their refusals may result in a conversation that could lead to positive results. A healthcare provider should never attempt to dissuade a patient from following their personal beliefs, but an open discussion about vaccinations allows the patient to reach an informed conclusion. In this instance, the healthcare provider principally plays the role of the “informer.” Correcting misconceptions and filling knowledge gaps using an individualized approach is the most efficient way to ensure that each patient consents to or refuses vaccinations after coming to a carefully deliberated and informed decision.

For a healthcare provider to fully understand the intricacy of the recent conversations about vaccination, it is useful to delve into the history of vaccinations, the perspectives of both early and recent patients, and current events that highlight the utility and necessity of this medical tool. Fundamentally, the issue revolves around open communication. Providing more education to parents has been shown to improve attitudes regarding immunization, though the effect on vaccination rates has not been elucidated.12 

Effects of COVID-19

The COVID-19 pandemic has added to the difficulties of providing immunizations due to a decrease in routine visits and a shift toward telemedicine. It is difficult to say what effect COVID-19 will have on vaccination rates long term. The argument could be made that witnessing a worldwide pandemic unfolding may improve vaccination rates, since parents can see the direct impact of COVID-19 while a vaccine is being developed.

Given the recent increase in vaccine refusal, providers have an overwhelming responsibility to ensure that all patients are making an informed decision. This requires a multifaceted approach. The provider must be able to provide standardized information about vaccinations. However, the provider must also address a patient’s specific needs and concerns. This requires the provider to listen a patient’s individual and unique perspective. With certainty, this approach will allow healthcare providers to provide efficient and complete care.

References

1. Measles Cases and Outbreaks. Centers for Disease Control and Prevention website. https://www.cdc.gov/measles/cases-outbreaks.html. Updated June 9, 2020. Accessed June 29, 2020.

2. Reviews. Vaccination: history and sociology. Brit Med J. 1927;1:1010.

3. Dikema DS. Improving childhood vaccination rates. N Engl J Med. 2012;366(5):391-393.

4. Zipprich J, Winter K, Hacker J, Xia D, Watt J, Harriman K; Centers for Disease Control and Prevention (CDC). Measles outbreak – California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep. 2015;64(6):153-154.

5. Centers for Disease Control and Prevention (CDC). Update: measles — United States, January–July 2008. MMWR Morb Mortal Wkly Rep. 2008;57(33):893-896.

6.  Centers for Disease Control and Prevention (CDC). Measles — United States, January–May 20, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(20):666-668.

7.  Centers for Disease Control and Prevention (CDC). Measles — United States, January 1–August 24, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(36):741-743.

8. Reported cases of notifiable diseases and rates per 100,000, excluding U.S. territories – – United States, 2016. Centers for Disease Control and Prevention website. https://wonder.cdc.gov/nndss/static/2016/annual/2016-table1.html. 2017. Accessed June 29, 2020.

9. Venkat H, Kassem AM, Su C, et al; Measles Investigation Team. Notes from the field: measles outbreak at a United States Immigration and Customs Enforcement facility ― Arizona, May–June 2016. MMWR Morb Mortal Wkly Rep. 2017;66(20):543-544.

10. Reported cases of notifiable diseases and rates per 100,000, excluding U.S. territories – – United States, 2017. Centers for Disease Control and Prevention website. https://wonder.cdc.gov/nndss/static/2017/annual/2017-table1.html. Published 2018. Accessed June 29, 2020.

11. Daley MF, O’Leary ST, Nyquist AC. Chapter 10: Immunization. In: Current: Diagnosis & Treatment. 23rd ed. McGraw-Hill Education; 2013.

12.  McKee C, Bohannon K. Exploring the reasons behind parental refusal of vaccines. J Pediatr Pharmacol Ther. 2016;21(2):104-109.  

13.  Flanigan J. A defense of compulsory vaccination. HEC Forum. 2014;26(1):5-25.