vaccine hesitancy & update - children's mercy … hesitancy & update angela myers md,...
TRANSCRIPT
10/15/2014
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© The Children's Mercy Hospital, 2014. 03/14
Constructing effective communication
strategies about vaccines to parents and
teens.
Vaccine Hesitancy & Update
Angela Myers MD, MPH
Associate Professor of Pediatrics
Children’s Mercy Kansas City
UMKC School of Medicine
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Learning Objectives
• Review the current immunization schedule
• Review methods to create a vaccine plan for any
pediatric patient
• Describe current barriers to immunization
• Analyze evidence based techniques to increase
immunization rates.
• Discuss methods to make a strong vaccine
recommendation
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Case Scenario • You overhear 2 mothers talking about vaccines
while you are at your child’s pre-school for parent-
teacher conferences
• The first mother says that she has not let her
children get their vaccines because you get better
immunity from disease than from vaccines
• The other mother recognizes that you are in
healthcare and pulls you into the conversation by
asking your opinion
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What every child needs….. • Hep B (3 doses; 0, 1-2, 6-18 mos)
• Rotavirus (2-3 doses; 2, 4, 6 mos)
• DTaP (5 doses; 2, 4, 6, 12-18 mos, 4-6 yrs)
• Hib (4 doses; 2, 4, 6, 12-15 mos)
• PCV (4 doses; 2, 4, 6, 12-15 mos)
• IPV (4 doses; 2, 4, 6-18 mos, 4-6 years)
• Influenza (annually ≥ 6 months)
• MMR (2 doses; 12-15 mos, 4-6 years)
• Varicella (2 doses; 12-15 mos, 4-6 years)
• Hep A (2 doses; 12-23 mos)
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What every adolescent needs...
• Tdap (1 dose; 11-12 yrs)
• HPV (3 doses; 11-12 yrs)
• MCV (2 doses; 11-12, 16-18 yrs)
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What is Vaccine Hesitancy?
• An expressed concern over a particular
vaccine(s) regarding its benefit and/or
potential for side effects; which may or
may not lead to refusal or acceptance of
the vaccine(s).
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Parents worry about the well being of
their children
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Vaccine Hesitancy
• The vaccine does not prevent the disease it is meant to
protect you from (disease is not dangerous)
• The vaccine may cause harm (concern for serious side
effects)
– the vaccine itself or “toxins” within the vaccine
• The vaccine is no longer necessary (child not at risk)
• The vaccines overload the immune system (too many,
too soon)
Salmon DA et al., Arch Pediatr Adolesc Med (2005) vol. 159 (5) pp. 470-6
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What are the concerns? Perspective % Agree or strongly agree
Getting vaccines is a good way to protect my child(ren) from disease.
90
Generally, I do what my doctor recommends about vaccines for my
child(ren).
88
I am concerned about serious adverse effects of vaccines.
54
New vaccines are recommended only if they are as safe as older vaccines.
51
Parents should have the right to refuse vaccines that are required for school
for any reason.
31
Some vaccines cause autism in healthy children.
25
My child(ren) do not need vaccines for diseases that are not common any
more.
11
Freed GL, et al. Pediatrics. 2010;125:564-659.
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Our Current Environment
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Know Your Audience
• Tailor your dialogue to match the needs
of your patient/parent
• 4 parent types:
– The believer
– The relaxed
– The cautious
– The unconvinced/conscientious objector
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© The Children's Mercy Hospital, 2014. 03/14
Parent Types
• Believers
• Relaxed
• Cautious
• Unconvinced
High commitment to vaccination
May ask about safety and side effects
High commitment to vaccination
Less likely to ask questions
May need to probe for unanswered questions
Moderate to low commitment to vaccination
High emotional involvement with child
Rigid thought patterns
May pick and choose some vaccines or delay
No commitment to vaccination
Serious doubts about efficacy and need
Potential harm outweighs benefit
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Parent Types
Spend Your Time Wisely
Believers Rejecters
Vaccine-hesitant
or
cautious
Cautious parent – 80/20 principal 80% of our time, 20% of our patients
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The Unconvinced/
Conscientious Objector
These patients choose the risk of
getting the disease versus the risk of
getting immunized.
In their context, they feel this choice is
the safer choice for them.
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The Unconvinced/
Conscientious Objector • Steer your conversation to a close;
• DON’T get into a lengthy debate
• Explain their responsibilities if unimmunized
• Closing idea:
– “I’m sensing that you won’t be immunizing your child
right now. Is your decision final? Is there anything
more I can say? I support immunizations as a healthy
choice for children. Let’s talk about this again later this
year”.
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A: Acknowledge your Client’s Concerns
and Clarify Your Understanding of Your
Client’s Needs
“I hear what you’re saying. That’s a common question I get. Tell me more about what you know.”
“That’s a scary story. I can see how you would be worried. Tell me more about your concerns.”
“It sounds like you want to do the right thing for your child. I’m hearing you say that you have concerns about….”
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S: Steer your Conversation.
First refute the myth(s), then continue…
Two steering choices
OPEN
your conversation to ensure
your client’s questions and
concerns are addressed
SKILLFULLY CLOSE
your conversation for now
Rational: your client is a
conscientious objector and has
firmly made up their mind not to
immunize at this time.
OR
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S: Steer your Conversation.
First refute the myth(s), then continue…
• “Actually, that’s a common myth. Vaccines protect you from the flu, they cannot give you the flu.”
• “Unfortunately the internet can have inaccurate information depending on where you look. The HPV vaccine prevents cancer and is very safe.”
• “When something like that happens it’s natural to look for a reason. Vaccines do not cause autism.”
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K: Knowledge – Know the Facts Well
1. Provide further knowledge tailored to your clients
needs.
Give-listen-clarify as needed
Use your toolkit
2. To close, reinforce discussion with a benefit statement
3. Provide further resources as needed
4. Provide your recommendation and immunize now, book
an appt, or ask what they plan to do
Prepare an immunization
communication toolkit
ready for use when the
crucial conversations
arise
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Understanding Vaccines & Vaccine
Safety
Topics of
concern/interest
to providers and
parents
Summary of key
points
Co-branded with
AAFP and AAP The science
Q&A format
Date
Current
stories
from
families
affected
by VPDs
Vaccine
risks and
benefits
VPD
risks
Quotes from
health care
professionals
Co-branded
with AAFP and
AAP
References
SERIES: Diseases & the
Vaccines that Prevent Them
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Parent-Targeted Materials
• Providers requested more
plain-language pieces for
parents
• More basic overview of
disease and vaccine
• Most have no story (or an
abbreviated version)
• Clearly shows benefits
and risks
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Websites • Provider Resources for Vaccine Conversations with
Parents
– www.cdc.gov/vaccines/conversations
• Give Feedback on Provider Resources
– www.cdc.gov/vaccines/tellus
• Health Care Professional Home Page
– www.cdc.gov/vaccines/hcp
• “Get the Picture” Childhood Video
– www.youtube.com/user/CDCStreamingHealth
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Being an Effective Communicator
Takes Purposeful Practice
Master the first seconds,
they count.
Communications and Public Relations:Presented by Andrew Hume and Associates Ltd.
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DON’T use: Medical Jargon
“Some children will have an adverse reaction
post immunization. They may develop
induration, erythema and an arthus type of
reaction. There is a 16.7% chance that your
child will develop a fever after DTaP-IPV-HIB.
There is a minute chance of anaphylactic
reaction. Therefore it is very unlikely that your
child will have a serious reaction.”
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DO use: Plain Language
Common side effects are redness, sore arm,
and fever. Tylenol helps. More serious
events are very rare.
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Plain Language Pyramid
Q: Does MMR cause autism?
“The MMR vaccine is very safe and protects
children, it does not cause autism.”
“The MMR vaccine is very safe and protects children. There is no increased risk of
autism with MMR vaccine. Because children are often diagnosed with autism at
around the same time as they get their shots people sometimes think it’s related to
the shots.”
“The MMR vaccine is very safe and protects children. The controversy about a possible link
started with a small study of 12 (8 had autism) children that appeared in the Lancet. Most of
the authors later retracted their findings. In May 2010 the lead author, Dr. Andrew Wakefield,
was found guilty of serious professional misconduct over “unethical” research and struck
from the medical registry in the UK. 23 studies refute this myth. One study looked at over
500,000 children and concluded there was no difference in rates between unvaccinated and
vaccinated children. You may wish to review the safety reviews posted at the IOM.”
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Use Stories • Stories are an acceptable and powerful
approach to teaching
• People relate to them
• They are easier to remember
• Talk from your own experience
• Stories can trump research
• Good book: Vaccine Preventable Disease: the
Forgotten Story
– http://www.texaschildrens.org/carecenters/vaccine/Vaccine_Book/default.aspx
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HALEIGH THROGMORTON
Pertussis or whooping cough
“It’s tough to see your child in
pain because of getting a shot,
but it passes. To see him or
her on a respirator, that’s
really tough. But to have to
plan a funeral for your child,
that’s the worst thing in the
world.”
– Rodney Throgmorton
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The Power of Painting Mental
Pictures
1. Does the picture tell a simple story?
2. Does it use basic emotional appeal?
3. Does it use easy arguments?
4. Does it match the message?
5. Does it pack a powerful impact?
6. Does it incorporate a call to action?
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SCENARIO
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Client Says…
Parent: “I think vaccines are good and my
other children have been vaccinated, but
what I read recently makes me wonder
about some things. I read on a vaccine
website that it’s better to get my baby
daughter’s shots one at a time over more
visits so her immune system can handle it
and won’t be overwhelmed.”
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You Say
HCP: “I hear what you’re saying, I
sometimes hear that concern from
parents. Tell me more about what you
read.”
Parent: “Well, I think it would be best if we
just get one vaccine today and hold off on
the rest until next time.”
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You Say
HCP: “Actually, what you read is a common myth.
I have a lot of experience giving multiple shots at
the same visit and babies handle them very well.
It’s very safe and helps babies get protection as
early as possible when they are most at risk.
Unfortunately, the internet can have a lot of
inaccurate information depending on where you
look. Do you have other concerns?”
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The Conversation
Continues…
Parent: “ Well yes, what about the side-effects,
are they greater?”
HCP: “Actually, that’s a common myth too. The
side-effects will be similar whether it’s one or
four. Giving all the shots now is the best way to
protect your daughter. Shall we give them all
today?”
Parent: “Yes, it sounds like that’s the best way to
do it”.
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Making the CASE for
Vaccines • Corroborate: Acknowledge the parents’ concern
and find some point on which you can agree. Set
the tone for a respectful, successful talk.
• About Me: Describe what you have done to build
your knowledge base and expertise
• Science: Describe what the science says
• Explain/Advise: Give your advice to patient,
based on the science
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I heard on TV that vaccines cause autism
• Corroborate: There’s certainly been a lot of coverage on television about
vaccines and autism so I can understand why you have questions
• About Me: I always want to make sure I’m up to date on the latest information
so that I can do what’s best for my patients, so I’ve researched this
thoroughly. In fact, I just returned from a professional conference…
• Science: Dozens of studies have been done, and they all showed that the
MMR vaccine is very safe and protects children. It does not cause autism.
• Explain/Advise: Vaccines are critical to maintaining health and help prevent
diseases that cause real harm. Choosing not to vaccinate does not protect
children from autism, but does leave them open to diseases. Kids need these
vaccines.
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1. Are you comfortable using personal stories?
2. Do you feel defensive when answering questions
about vaccines? Why? Why not?
3. Do you feel confident? What makes you feel that
way?
4. Do you know an immunizer who has personal issues
or biases?
5. What does making a recommendation mean to you?
6. What could I have said differently (in a talk that didn’t
go so well)?
Self Reflection Questions
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Thank you for your
attention and participation
today!