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Talking with vaccine-hesitant parents takes training and finesse

 

Key clinical point: Pediatricians can use tactics to help reduce the anxiety of discussing the importance of immunization with vaccine-hesitant parents.

Major finding: The CASE approach was easier to learn and used more readily when pediatricians encountered a moderately hesitant parent, but pediatricians perceived motivational interviewing as useful for the more strongly resistant parent.

Data source: Pilot study of five pediatric providers who received comprehensive training and ongoing support using different communication techniques.

Disclosures: Ms. Dybsand and Dr. Carson had no relevant financial disclosures.


 

AT AAP 2017

 

– Addressing vaccine-hesitant parents can cause physicians considerable stress. However, they can feel more confident by adopting one of two communication strategies after gauging the strength of antivaccine beliefs, results of a pilot study suggest.

“We found that physicians frequently feel anxious and uncomfortable when confronted with parents who are strongly vaccine hesitant. They frequently lack confidence in dispelling the various safety concerns raised by parents and find themselves frequently combating an internal desire to just avoid the conflict,” said Paul J. Carson, MD, an expert in infectious diseases in the department of public health at North Dakota State University in Fargo.

Doctor speaking with parents who are holding young girl. Wavebreakmedia/Thinkstock
“After we got to know these pediatric providers, we realized the incredible stress they encounter when trying to approach these conversations,” lead researcher Lauren Lee Dybsand, MPH, said in an interview at the annual meeting of the American Academy of Pediatrics.

The AAP suggests pediatricians adopt the “CASE method,” which stands for Corroborate parents’ concern, talk About me, describe the Science, and Explain/advise why they should vaccinate. The academy also recommends motivational interviewing as an additional tool to achieve vaccine acceptance. Ms. Dybsand, Dr. Carson, and their colleagues examined these two different approaches after training five pediatric providers. They also assessed physician perceptions about confidence and satisfaction regarding each method.

The pediatric providers were trained during a 7-hour retreat and 10 subsequent 1-hour training/debriefing sessions over 9 months. Explanations of vaccine safety and efficacy, vaccine licensure, how to refute common vaccine myths, and the two differing communication strategies were included in the training. Participants implemented the presumptive/CASE approach for 4 months then crossed over and used motivational interviewing for an additional 4 months.

“Some intensive training and education on the vaccine safety process and scientific evidence dispelling the common myths about vaccine safety were very helpful in boosting provider confidence,” Dr. Carson said.

“We want to be able to give them the tools to approach these conversations in an educated manner. We want them to feel like they have some ammunition behind the conversation,” said Ms. Dybsand, a graduate research assistant at the university.

The study revealed that the CASE approach was easier to learn and used more readily when pediatricians encountered a moderately hesitant parent. However, the investigators found the pediatricians perceived motivational interviewing as useful for the more strongly resistant parent. “For those really resistant parents who have looked at all the websites and are very concerned about vaccines, maybe motivational interviewing is the way to go,” Ms. Dybsand said. The goal of motivational interviewing is to build a trusting relationship over time. “You may not be giving that vaccine today, but you may be able to convince them in the future to vaccinate.”

The frequency and duration of training may be essential to success. “We didn’t really set out to find this, but it really takes more than 1 day of training to get providers to make a meaningful change in their communication strategies,” Ms. Dybsand said. When asked how long it might take the average pediatrician to become proficient in both techniques, she said that likely is a focus of future study.

The investigators plan to build on the success of the pilot study by expanding the research to multiple sites. In addition, they want to go beyond assessing provider perceptions of the communication techniques. Dr. Carson said, “These strategies need to be tested in formal clinical trials to see what is successful in actually increasing vaccine acceptance.”

Ms. Dybsand and Dr. Carson had no relevant financial disclosures.
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