How to Talk to Reluctant Patients About the Flu Shot


This three-step framework can help you address patients' concerns about influenza immunization.

Fam Pract Manag. 2017 Sep-Oct;24(5):6-8.

Author disclosures: no relevant financial affiliations disclosed.

Thousands of people are hospitalized each year due to influenza, despite it being easily preventable with vaccines.1 Patients who decline flu vaccination generally fall into two categories: the “chronic no” (those who have unequivocally refused the vaccine for years) and the “undifferentiated no” (those who have declined for reasons we have yet to explore). After eight years of working together, we have developed a team-based routine that has improved our efficiency and effectiveness in getting our patients vaccinated.

The nurse's role: Setting the stage

I (Crues) am in charge of asking patients about influenza vaccinations and informing Dr. Fogarty if they have concerns, fears, or anxiety about the flu shot. During flu season, I ask patients as part of the rooming process if they would like a flu vaccine. If a patient declines, I ask if the patient minds sharing his or her fears and concerns and then listen to the response. When appropriate, I share my own story of receiving a flu shot after years of declining and not having any problems with it. I also give the patient a flu vaccine information sheet, which the patient can review while waiting for Dr. Fogarty to come into the exam room. I work with the language interpreter or seek other help for patients who have trouble understanding the information.

In the electronic health record (EHR), I type each of the patient's chief complaints for the visit and add “Wants fluvax” or “Declines fluvax” in the last line. This makes Dr. Fogarty aware of the patient's intentions for the flu shot before entering the exam room, which saves a lot of time during the visit.

Patients who either request the flu vaccine or indicate that they received it at an outside location require little to no extra conversation. If the patient received the shot elsewhere, I request the record and enter the date into our chart. For patients who request a shot, Dr. Fogarty quickly orders it before entering the room so I can get the vaccine ready. Sometimes I can administer the vaccine before Dr. Fogarty's consultation. Overall, our team approach can reduce the total time the patient is in the office.

For the “chronic no” patients, who have generally declined the flu shot for years despite our education efforts, we don't challenge them beyond a brief check-in; we use our time to discuss other clinical concerns. It is the “undifferentiated no” patients our conversations can potentially influence.

The physician's role: Ask-Tell-Ask

I (Fogarty) handle these visits using the “Ask-Tell-Ask” framework, which was derived

About the Authors

Dr. Fogarty is an associate professor at the University of Rochester's Department of Family Medicine in Rochester, N.Y., where she is medical director of Highland Family Medicine and associate chair for clinical practice and interprofessional education. She also directs the Finger Lakes Center for Primary Care Clinician Education and spent 13 years practicing at Jordan Health's Brown Square Health Center, a federally qualified health center in Rochester, N.Y. LaTresha Crues is a licensed practical nurse at the Brown Square Health Center.

Author disclosures: no relevant financial affiliations disclosed.



show all references

1. Situation update: summary of weekly fluview report. Centers for Disease Control and Prevention website. May 26, 2017. Accessed July 21, 2017....

2. Boxer H, Snyder S. Five communication strategies to promote self-management of chronic illness. Fam Pract Manag. 2009;16(5):12–16.

3. Davis C. What is ‘Ask, Tell, Ask’? [Video] Institute for Healthcare Improvement Open School website February 4, 2016. Accessed June 29, 2017.

4. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;191–111.

5. Gaster B, Edwards K, Trinidad SB, Gallagher TH, Braddock CH 3rd. Patient-centered discussions about prostate cancer screening: a real-world approach. Ann Intern Med. 2010;153(10):661–665.


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