Vaccine Hesitancy & Update. Learning Objectives. Case Scenario 10/15/2014

Transcription

1 Vaccine Hesitancy & Update Constructing effective communication strategies about vaccines to parents and teens. Angela Myers MD, MPH Associate Professor of Pediatrics Children s Mercy Kansas City UMKC School of Medicine 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 2 Case Scenario You overhear 2 mothers talking about vaccines while you are at your child s pre-school for parentteacher 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 3 1

2 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, mos, 4-6 yrs) Hib (4 doses; 2, 4, 6, mos) PCV (4 doses; 2, 4, 6, mos) IPV (4 doses; 2, 4, 6-18 mos, 4-6 years) Influenza (annually 6 months) MMR (2 doses; mos, 4-6 years) Varicella (2 doses; mos, 4-6 years) Hep A (2 doses; mos) 5 What every adolescent needs... Tdap (1 dose; yrs) HPV (3 doses; yrs) MCV (2 doses; 11-12, yrs) 6 2

3 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). 7 Parents worry about the well being of their children 8 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

4 What are the concerns? Perspective Getting vaccines is a good way to protect my child(ren) from disease. Generally, I do what my doctor recommends about vaccines for my child(ren). I am concerned about serious adverse effects of vaccines. New vaccines are recommended only if they are as safe as older vaccines. Parents should have the right to refuse vaccines that are required for school for any reason. Some vaccines cause autism in healthy children. My child(ren) do not need vaccines for diseases that are not common any more. % Agree or strongly agree Freed GL, et al. Pediatrics. 2010;125: Our Current Environment 11 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 12 4

5 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 Parent Types Spend Your Time Wisely Believers Vaccine-hesitant or cautious Rejecters Cautious parent 80/20 principal 80% of our time, 20% of our patients 14 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

6 16 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

7 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 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 OR 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 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

8 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 8

9 Understanding Vaccines & Vaccine Safety Q&A format Topics of concern/interest to providers and parents Summary of key points Date Co-branded with AAFP and AAP The science SERIES: Diseases & the Vaccines that Prevent Them Quotes from health care professionals VPD risks Current stories from families affected by VPDs Co-branded with AAFP and AAP Vaccine risks and benefits References 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 9

10 Websites Provider Resources for Vaccine Conversations with Parents Give Feedback on Provider Resources Health Care Professional Home Page Get the Picture Childhood Video 28 Being an Effective Communicator Takes Purposeful Practice Master the first seconds, they count. 29 Communications and Public Relations:Presented by Andrew Hume and Associates Ltd. 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

11 DO use: Plain Language Common side effects are redness, sore arm, and fever. Tylenol helps. More serious events are very rare. 31 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. 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

12 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 P A G E 1 plan a funeral for your child, O F that s the 2 worst thing in the world. Rodney Throgmorton 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? 35 SCENARIO 36 12

13 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 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 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?

14 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 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 42 14

15 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. 43 Self Reflection Questions 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)? 44 Thank you for your attention and participation today! 45 15