Pediatricians' Verbal Cues Affect Decision to Vaccinate

Troy Brown, RN

November 04, 2013

The approach a physician uses to discuss vaccinations plays a significant role in whether or not parents choose to have their child vaccinated at that visit, according to a cross-sectional observational study in which 111 provider–parent vaccine discussions during health supervision visits were recorded and analyzed.

Douglas J. Opel, MD, MPH, an assistant professor in the Division of Bioethics and the Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, and at the Treuman Katz Center for Pediatric Bioethics at Seattle Childrens Hospital, Seattle Children's Research Institute, Washington, and colleagues report their findings in an article published online November 4 in Pediatrics.

"Although the linguistic format of how a topic is introduced has received attention in other medical settings, it has not yet been explored in the context of vaccine discussions," the authors write.

The study included parents of children aged 1 to 19 months who were screened with the Parent Attitudes About Childhood Vaccines survey. Vaccine-hesitant parents (VHPs) were defined as those having a score of 50 or higher. The researchers developed a coding scheme of 15 communication practices and applied it to all patient encounters.

A provider was using a presumptive format when he or she presumed that the parent would be willing to have the child vaccinated that day (eg, "Well, we have to do some shots"). Providers who used a participatory linguistic format (eg, "What do you want to do about shots?" "Are we going to do shots today?") gave the parent more decision-making latitude.

In multivariate logistic regression analyses, the researchers controlled for parental hesitancy status and demographic and visit characteristics.

A total of 111 vaccine discussions took place between 16 providers from 9 practices, half of which included VHPs. Three fourths (74%) of providers began vaccine recommendations with presumptive vs participatory formats.

Among those who were resistant on provider initiation (41%), a significantly higher number were VHPs than non-VHPs. Parents were significantly more likely to resist vaccine recommendations if the provider used a participatory instead of a presumptive initiation format (adjusted odds ratio, 17.5; 95% confidence interval, 1.2 - 253.5).

Half of the providers handled parental resistance by repeating their original recommendations (eg, "He really needs these shots"), and when that happened, almost half (47%) of parents who were initially resistant then accepted those recommendations.

Longitudinal studies will need to be conducted with a more diverse population of parents and healthcare providers, the researchers note.

"How providers initiate their vaccine recommendations at health supervision visits appears to be an important determinant of parent resistance to that recommendation," the authors write. "[I]f providers continue to pursue their original recommendation after encountering parental resistance, many parents eventually agree to it," they conclude.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 4, 2013.

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