As outbreaks of preventable diseases such as measles continue to pop up across the country and as many states grapple with legislation on nonmedical vaccine exemptions -- both pro and con -- family physicians can expect to encounter vaccine-hesitant parents in their practices. Now, new guidance(www.cfp.ca) published in Canadian Family Physician addresses vaccine hesitancy in its many forms and provides tips and resources family physicians can use when discussing concerns about vaccines with parents.
The Role of the Family Physician
The article's authors cite research(www.ekospolitics.com) indicating that more than 60 percent of Canadian parents go online to find information on childhood immunizations, calling this figure "concerning" because vaccination information found on websites and social network groups is often deliberately misleading or negative.(www.ncbi.nlm.nih.gov)
Still, the authors point out, the same research report indicated that more than 50 percent of parents received vaccine information from their physicians, and more than two-thirds said they thought health care professionals such as family physicians were the most reliable and trustworthy source of this information. Findings such as these highlight the important role family physicians can play in counseling parents and building up their confidence in vaccines, the authors contend.
In line with previous research(www.sciencedirect.com) that has suggested the most effective interventions are those that utilize multiple strategies, the authors offer a series of practical, evidence-based tips for discussing the importance of vaccines with parents who may be on the fence:
- Many parents are vaccine-hesitant and have questions or concerns about having their children immunized.
- New guidance published in Canadian Family Physician offers tips and resources for family physicians to address vaccine hesitancy with parents.
- The AAFP has a wealth of additional resources on vaccines and vaccine-related topics.
- Start early. It's important that physicians talk with parents about vaccines during prenatal visits and the first few postnatal appointments to educate them about vaccinations and provide them with fact-based materials or links to reliable websites.
- Present vaccination as the default option. A presumptive approach that assumes parents will immunize their child has been shown to be more effective than a participatory approach, which can offer vaccine-hesitant parents more opportunity to resist vaccine recommendations.
- Be honest about side effects. When parents ask about possible adverse effects of vaccination, provide them accurate information and reassure them that a robust vaccine safety system is in place.
- Tell parents stories. Supplement scientific facts with personal experiences -- for example, physicians can tell parents what they do for their own children regarding immunizations.
- Build trust with parents. Showing respect, displaying empathy and tailoring information to each parent helps ensure vaccine compliance.
- Address the pain associated with vaccination. Inform parents about what pain can be expected after vaccination, and reassure them that any vaccination-related pain is typically mild and transient.
- Focus on protection. Emphasize to parents that vaccinations not only protect the child but reduce the likelihood of outbreaks, which helps to protect the community at large.
The guidance also provides tables that offer the following information:
- sample statements that physicians can use in conversation with parents,
- answers to commonly asked questions,
- online resources that provide the latest vaccine-related information for health care professionals and parents, and
- interventions to reduce vaccination-associated pain.
In conclusion, the authors acknowledge that vaccine hesitancy is an important issue and that decisions about vaccination are complex. As a trusted source of information, however, physicians can play an important role in helping parents overcome their vaccine hesitancy.
Family Physician Expert Perspective
Margot Savoy, M.D., M.P.H., a former chair of the Academy's Commission on Health of the Public and Science, a former AAFP Vaccine Science Fellow and a former AAFP liaison to the CDC's Advisory Committee on Immunization Practices, told AAFP News that the guidance offered in the article aligns well with the information the AAFP and CDC provide.
Savoy noted that although she hasn't experienced an increase in parents who are hesitant about vaccines per se, she has seen an increase in parents who aren't hesitant to ask questions about them.
"I've had more engaged parents who feel comfortable asking me about things they've heard on TV or read on the internet," Savoy said. "We talk about their concerns, I answer and address their concerns, and then they make their decision."
Savoy's approach is to give parents advance information about the vaccines that she will administer at a child's next visit. "Sometimes that allows us to chat about immunization concerns ahead of time," she explained.
In other instances, Savoy said she and the parents discuss the vaccines that are due, which she follows with a strong recommendation to administer the vaccines then and there. If parents appear nervous or concerned during the conversation, she takes notes and addresses the parents' concerns one by one.
"If a parent says no even after our conversation, I let them know they have the option to change their mind at any time, including between now and our next visit, since I can order vaccines as a nurse visit," Savoy said.
One thing Savoy tries not to do is lecture parents -- or any patients -- about how vaccines save lives.
"That approach may make me feel better in the moment, but it really doesn't help anyone," she said. "All parents are looking to provide their children the best care, so lecturing them comes across as paternalistic and not very compassionate."
Savoy told AAFP News that the questions she gets are as varied as the patients who ask them. To aid in the discussion, she recommends that FPs ask patients to show them where they got their information on vaccines.
"It helps for you to know what they are reading or talking about," Savoy said, adding that she doesn't dismiss information that parents got from social media out of hand.
"Social media can be a great source of valuable support and even accurate content, but it also has a dark side … we talk about verifying information, locating original sources and identifying trusted sources of information. I've learned about some great apps to share with other patients this way and also have been able to help patients identify scams a little better."
More Resources to Explore
Savoy recommended that FPs visit the Academy's immunizations page for information on childhood and other vaccines. For adolescents, she also pointed to the resources and information available from the AAFP Adolescent Immunization Best Practices Summit.
Along with Academy sources, Savoy recommended that family physicians visit the Immunization Action Coalition website(www.immunize.org) and read a report(pediatrics.aappublications.org) from the American Academy of Pediatrics on addressing vaccine hesitancy.
Additional information is available from the CDC. The agency started running a series of children's videos(www.youtube.com) titled "How Vaccines Work" in January and also offers other online resources(www.cdc.gov) clinicians can use when talking with parents about vaccines.
Overall, Savoy stressed the role of family physicians in helping parents make informed decisions about vaccinating their children based on the best available evidence.
"Vaccines are common sense to us," she said. "We know the risks of the diseases we are trying to prevent, and we care about our patients and our communities, so anyone making choices that threaten the health of our patients become easy targets for ridicule and vilification.
"Many of the vaccine-hesitant parents are inundated with conflicting information and are unsure," Savoy added. "The health of their children is very important, and they want to make the right decision. It's our job to work with them to help them make educated, evidence-based decisions. Fortunately, shared decision-making is something family physicians do all day."
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