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Discussing vaccines with patients

Healthcare professionals as trusted sources of information

As trusted advisers on vaccination decisions, healthcare workers have a key role to play when discussing vaccination with patients.1-3

Calls to action

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The importance of trusted communication with healthcare workers, both during consultations with individuals and as part of wider conversations using different media, is highlighted by calls from global, regional and national organisations:

  • The World Health Organization (WHO) states ‘health workers must be supported to provide trusted, credible information on vaccines’1
  • The European Immunization Agenda 2030 calls to ‘ensure that the entire health workforce… has the capacity to effectively communicate the benefits of immunization and address questions and concerns raised by the public’4
  • The UK Local Government Association recommends enlisting people who are ‘perceived to have authority or expertise to deliver vaccine communications, such as faith leaders, community leaders, or local GPs’5

Healthcare professionals are well placed to share both the evidence and their own experience2

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  • Experience: As healthcare professionals are knowledgeable about vaccines and often among the first to receive vaccinations, they can speak authoritatively to patients about their own decision to receive vaccines2
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  • Evidence: Informed choices require an understanding of diseases prevented by vaccination and of the benefits and risks of (i) immunisation and (ii) delaying or refusing vaccination.3,6 A comprehensive understanding of vaccination and vaccine hesitancy helps healthcare professionals guide patients and parents in decision-making about vaccines

The WHO has shared the following simple tips on how to talk about vaccines:7

  1. Listen with empathy
  2. Ask open-ended questions
  3. Share trusted information
  4. Share your own reasons for wanting to get vaccinated

However, as for any shared decision-making with patients, a range of models can help guide discussions about vaccines.8,9 Here you can find brief reminders of just a few of these models.

  • BRAN: Benefits, risks, alternatives and doing nothing9,10

    Choosing Wisely UK encourages a collaborative process in which healthcare professionals and patients work together to make shared decisions based on clinical evidence and patients’ informed preferences and values. Their simple framework to guide discussions includes four key questions:9-11

    1. What are the Benefits?
    2. What are the Risks?
    3. What are the Alternatives?
    4. What if I do Nothing?

  • Another way to support people when they are considering options incorporates chunk and check with teach back:8

    1. Break information down into small, manageable chunks instead of providing it all at once
    2. In between each chunk, check the patient has understood the information using teach back, which involves asking people to ‘teach back’ what has just been discussed. Teach back is a useful way to confirm how well information is being understood
    3. Discuss what matters to your patient in light of the information provided and check their choice is consistent with this

  • Motivational interviewing is an evidence-based way to approach discussions in a culturally sensitive manner and can help patients make decisions that fit their own values and needs in four steps:12,13

    1. Embrace a non-judgemental attitude of empathy and collaboration
    2. Ask for permission to discuss vaccines and signal the patient’s freedom of autonomy
    3. Ask a scaled question, such as ‘On a scale of 1 to 10, how likely are you to get this vaccine?’, and then ask the patient to explain why they chose that number compared with a higher or lower number
    4. Respond to the patient’s questions with empathy and scientific information, directing patients to other knowledgeable experts as needed

  • The three-talk model involves basing discussions around three steps:8

    1. Introducing choice
    2. Describing options
    3. Helping people explore their preferences and make decisions

Have you heard about ‘Cow-Mania’?

Resistance to vaccination, scepticism and suspicion among members of the public are not new.2,14 They have existed for as long as vaccines themselves:14

When Edward Jenner published his findings on using the cowpox virus to stimulate an immune response that protected against smallpox, concerns among the general public included the possibility of the vaccine causing ‘Cow-Mania’, with illustrations depicting an ox-faced boy and an elderly woman who allegedly grew horns after being vaccinated.2

Key points: Discussing vaccines with patients

  • Healthcare workers are trusted advisers on vaccination decisions1-3
  • Healthcare professionals are well placed to share both the evidence and their own experience with patients during discussions about vaccines2
  • Suggested approaches to discussions include listening with empathy, asking open-ended questions, providing trusted information and sharing your own reasons for wanting to get vaccinated7

References

  1. World Health Organization. Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 (accessed February 2024).
  2. Nuwarda RF et al. Vaccine hesitancy: Contemporary issues and historical background. Vaccines (Basel) 2022;10:1595.
  3. The Lancet Child & Adolescent Health. Vaccine hesitancy: A generation at risk. Lancet Child Adolesc Health 2019;3:281.
  4. World Health Organization Europe. European Immunization Agenda 2030. https://iris.who.int/bitstream/handle/10665/348002/9789289056052-eng.pdf?sequence=1 (accessed March 2024).
  5. Local Government Association. Applying behavioural insights to improve COVID vaccination uptake: A guide for councils. https://www.local.gov.uk/publications/applying-behavioural-insights-improve-covid-vaccination-uptake-guide-councils (accessed March 2024).
  6. Butler R et al. Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine 2015;33:4176–4179.
  7. World Health Organization. How to talk about vaccines. https://www.who.int/news-room/feature-stories/detail/how-to-talk-about-vaccines (accessed March 2024).
  8. National Institute for Health and Care Excellence. Shared decision making. https://www.nice.org.uk/guidance/ng197 (accessed March 2024).
  9. Centre for Perioperative Care. Shared decision making. https://cpoc.org.uk/shared-decision-making (accessed March 2024).
  10. Choosing Wisely UK. Make the most of your appointment. https://choosingwisely.co.uk/wp-content/uploads/2020/11/CWUK_patient_leaflet_100120-1.pdf (accessed March 2024).
  11. Choosing Wisely UK. About Choosing Wisely UK. https://choosingwisely.co.uk/about-choosing-wisely-uk/ (accessed March 2024).
  12. Centers for Disease Control and Prevention. Talking with patients about COVID-19 vaccination. An introduction to motivational interviewing for healthcare professionals. https://www.cdc.gov/vaccines/covid-19/hcp/engaging-patients.html#print (accessed March 2024).
  13. Schmid P. Using behavioral science for infodemic preparedness: The case of vaccination misinformation. Policy Insights Behav Brain Sci 2023;11:93–101.
  14. Hickler B et al. Vaccine special issue on vaccine hesitancy. Vaccine 2015;33:4155–4156.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

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June 2024 | NP-GB-ABX-WCNT-240007 (V1.0)