November 4, 2013
News Review From Harvard Medical School -- Study: Doctor's Words Affect Vaccine Decisions
The way a child's doctor brings up the subject of shots may make a big difference in whether parents agree to them, a new study shows. If the doctor starts out with a question, the parents are much more likely to say no. Researchers videotaped 111 vaccine discussions between parents and doctors. About 3 out of 4 doctors used "presumptive" language, such as, "We have to do shots." The others used "participatory" language. For example, they might ask: "What do you want to do about shots?" Parents were 17 times as likely to object to shots if the doctor used the participatory language. About half of the time, the doctor persisted, saying that the shots were necessary. In this case, about half of the resistant parents agreed to the shots. In recent years, more doctors have encouraged patients to share in making decisions about their health. But in this case, an expert told HealthDay News, using "participatory" language may incorrectly suggest to parents that the doctor is not certain about the value of vaccines. The journal Pediatrics published the study. HealthDay News wrote about it November 4.
By Claire McCarthy, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Whether or not people agree to get shots for their children may have a lot to do with whether doctors tell parents to get them, or ask if they want them.
That's the message of a study from researchers in Seattle. They videotaped 111 doctor's visits. They looked to see how doctors started the vaccine conversation. Specifically, they looked to see which of these formats doctors used:
- "Presumptive," such as, "We have to do some shots today."
- "Participatory," such as, "What would you like to do about shots today?"
The majority of the doctors (74%) used a presumptive format. They told rather than asked. And that kind of approach worked better when it came to getting children immunized. If doctors asked rather than told, parents were much more likely to resist or refuse.
When parents were resistant, only half of the doctors persisted. For example, they might say, "He really needs these shots." When doctors persisted, 47% of those who resisted at first ended up accepting the shots.
In general, doctors are being encouraged to bring patients and families into the decision-making process. It's called "shared decision making," and it's thought to be a good idea. It can help families to:
- Voice their concerns
- Learn about their health care
- Take more responsibility for decision-making and treatment
- Build the relationship with the doctor
But in this study, shared decision-making led to fewer children being immunized, and that's not a good thing.
However, as the researchers point out, "Shared decision-making is typically not indicated when there is only one medically acceptable choice." Most doctors do see immunization that way. That's why they don't think about it as something they should discuss with families. However, not all families agree.
One worrisome result of the study was that doctors only asked families if they had questions about vaccines one-quarter of the time. They only talked about side effects and why we give vaccines one-third of the time. Whether or not doctors want to make giving vaccines optional, it's important that families be informed and get to ask questions.
What Changes Can I Make Now?
Vaccines, like any medical treatment, can have side effects. However, many of the concerns that vaccine-hesitant parents have are unnecessary. For example, some parents believe that there is mercury in the routine vaccines we give small children. This is not correct. Some parents also think that drug companies or the Centers for Disease Control and Prevention (CDC) hide information about "adverse events" that may occur after shots are given. Actually, there is a publicly available registry of all reports that come in.
It's important that families learn about vaccines and vaccine-preventable diseases. Try to do this before you bring your child to the doctor. That way, you can come in to the doctor's visit ready to ask questions and talk about any concerns. The best resource to use is the CDC's website. This site has information on anything you might want to learn about vaccines and the diseases they prevent.
What Can I Expect Looking to the Future?
U.S. health officials have set down their goals for our nation's health in a document called Healthy People 2020. One of the goals is for 80% of children ages 19 to 35 months will have all of their recommended vaccines.
We aren't there yet. And the results of this study suggest that if we want more children to be immunized, doctors should tell parents to get the vaccines rather than ask if they want them.
At the same time, families should be able to ask questions, make informed choices and be happy with their choices. The challenge will be to find the best way to do this -- and get more children immunized.