• Survey Outlines FPs’ Challenges on COVID-19 Vaccines

    AAFP Resources Assist With Gaps Revealed in Report

    September 21, 2022, 3:25 p.m. Michael Devitt — Family physicians are extremely confident in the safety and efficacy of COVID-19 vaccines and are experts at telling patients about their importance. Yet at the same time many are concerned about misinformation and about discussing COVID-19 vaccination with their patients.

    Physician talking with younger patient

    Those are among the conclusions in “COVID-19 Vaccines: A Survey of Attitudes and Practices Among Family Physicians,”  a report by Lisa Doggett, M.D., M.P.H., and Anne Schneider, D.O., the Academy’s 2021-2022 Vaccine Science Fellows.

    “Family physicians can feel validated by these results,” said Doggett, the senior medical director for Sagility (formerly HGS Healthcare/AxisPoint Health), who is based in Austin, Texas. “We are struggling with patients who express discomfort with the vaccines or flat-out refuse to be vaccinated. It’s helpful to know our peers and colleagues are experiencing the same thing. It’s a challenge for everyone.”

    The authors set out to assess family physician confidence in COVID-19 vaccines and understand how often FPs were hesitant about discussing COVID-19 vaccination with their patients. The survey was sent to a random sample of 5,000 active AAFP members in February 2022; just over 300 members responded.

    High Confidence in Vaccines

    Most respondents had a favorable view of COVID-19 vaccines and of their ability to talk about them:

    • 97% were fully vaccinated and 88% had received at least one booster. In comparison, the CDC estimated this month that, 77.4% of all U.S. adults are fully vaccinated and 51.7% have received at least one booster.
    • 90% were confident of their knowledge.
    • 74% thought their recommendations affect patients’ decision to get vaccinated.
    • The most popular technique to improve vaccine acceptance was motivational interviewing (39%), followed by facts and data (38%).

    In another notable finding, the vaccination rate of family physicians’ children was significantly higher than that of children at large — 86% for 5- to 11-year-olds and 88% for 12- to 17-year-olds among FPs’ children, compared with 31% of 5- to 11-year-olds and 60% of 12- to 17-year-olds in the general population.

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    Opportunities for Improvement

    At the same time, the survey authors noted concerning findings.

    For example, 47% of respondents were uncomfortable discussing COVID-19 vaccines, although 89% said it’s an important part of their job.

    “As noted by the survey respondents, it’s difficult and time-consuming to raise a controversial topic with a patient,” Doggett said. “These conversations can be exhausting and frustrating. Some physicians also worry about damaging their relationship with a patient who may become upset by the conversation.”

    Doggett was troubled to find that 33% of respondents said their patients are now more hesitant to receive any routine vaccines, especially given the need for catch-up since tens of millions of routine vaccines have been missed during the pandemic.

    “Talking to people who express reservations about vaccines is a challenge,” she acknowledged. “It takes time and can be discouraging, but I think family doctors are well-positioned to help persuade hesitant patients, especially when we have an established, trusted relationship with someone.”

    Fifty-nine percent of respondents said better resources on misinformation would help them with discussions on all routine vaccinations, and 51% said more time to talk with patients would improve the experience.

    “As a practicing physician, as I am sure is the case with most practicing physicians, I am always wishing for more time to spend with patients,” said Schneider, a member of Edward-Elmhurst Medical Group in Naperville, Ill., and medical director of the Dyson Wellness Center at North Central College in Naperville. “Talk with your administrators about allowing for more time for certain visits, if possible. Some of my colleagues allow for 40 minutes for well visits, where that conversation about vaccines is most likely to occur.”

    Academy Resources Help

    For more than two years, the AAFP has been developing resources to help family physicians overcome the types of challenges that the survey found.

    Members get regularly updated COVID-19 information on clinical resources and patient education and vaccines at aafp.org, and they can refer patients to familydoctor.org to learn how to debunk common myths.

    The Academy worked with Pfizer Inc. this year to publish two factsheets — “How to Approach Conversations With Parents About Routine Pediatric Vaccinations” and “Building Confidence When Talking to Parents About Children’s Vaccines” — on the Immunizations & Vaccines webpage.

    An FPM Quick Tips blog describes the OARS (open-ended questions, affirmations, reflective listening, summarize) technique for motivational interviewing, and a video series shows how techniques such as reflective listening increase vaccination rates among hesitant patients.

    “Motivational interviewing is a great strategy, and for physicians who don’t know a lot about it, they might want to learn more after seeing that their colleagues find it helpful,” said Doggett.

    Doggett also recommended the U.S. surgeon general’s toolkit for addressing health misinformation and a vaccine hesitancy guide developed by the University of Calgary School of Public Policy in consultation with several family physicians.

    “To address vaccine hesitancy and refusal at a national level, we need to study and disseminate new, effective methods to identify and eliminate misinformation,” Doggett said. “We need to rebuild trust in health leaders but recognize the medical community cannot solve this problem alone. We must come together to collaborate on ways to promote confidence and acceptance of vaccines — one of our most powerful tools to save lives.”