Research finds physicians' approach influences resistance to immunizations
MONDAY, Nov. 4, 2013 (HealthDay News) -- The way a doctor talks about vaccines can make a difference in whether or not parents resist shots for their child, new research suggests.
Parents are much less likely to resist these immunizations, the study found, if a doctor uses language that presumes the parent will accept the vaccines, such as "We have to do some shots," instead of language that suggests that vaccinations need to be discussed and then decided on, such as "What do you want to do about shots?"
"We know that one of the most important influences on parents' decision-making on childhood vaccinations is the pediatrician, but that conversation doesn't always go well," said study author Dr. Douglas Opel, an assistant professor of pediatrics at the University of Washington School of Medicine in Seattle. "We wanted to see how the actual conversation happens and if we could parse out specific elements in the conversation."
It turns out how a doctor starts the vaccine discussion is an important predictor of how more or less resistant a parent is to vaccines, said Opel. "If doctors start with a question, parents were more likely to argue than if they were simply told it was time for a vaccine," he explained.
Rates of some childhood vaccinations in the United States are below the 80 percent goal set in the Healthy People 2020 report, according to background information in the study. Although research suggesting a link between childhood vaccinations and autism has been discredited, the number of parents who have concerns about vaccines remains high. And the rate of nonmedical exemptions for vaccines increases each year. Such vaccination lapses have been cited as a cause of sporadic outbreaks of whooping cough (pertussis) and measles, experts say.
In previous research, the child's health care provider has been cited as an important factor in a parent's decision about whether to have their child vaccinated or not, according to the current research.
For this study, released online Nov. 4 and in the December print issue of the journal Pediatrics, Opel and his colleagues analyzed 111 vaccine discussions between parents and 16 doctors at nine practices. Half of these discussions included parents who were hesitant about vaccines.
Most physicians -- 74 percent -- used presumptive language, such as "We have to do shots," instead of participatory language, such as "What do you want to do about shots?"
The odds of parents raising an objection to vaccination were more than 17 times higher if a doctor used participatory language rather than presumptive language, the study found.
If parents resisted the vaccine, half of the providers continued with their initial recommendation, saying something like, "He really needs these shots." And 47 percent of the initially resistant parents chose to follow that recommendation.
"The participatory language suggests shared-decision making, and this isn't necessarily a time to share a decision with parents. There isn't a choice here. There's no other medically accepted option," noted Opel.
Another expert agreed.
"By asking parents what they want to do about shots, you're sending a subliminal message to parents that maybe you don't really believe that they're necessary," said Dr. Kenneth Bromberg, director of the Vaccine Research Center and chairman of pediatrics at the Brooklyn Hospital Center in New York City.
"When you're perceived as ambivalent and pretend there are two sides to a story, it sounds like you don't feel as strongly as you do about vaccinations," he said.
Pediatricians may try to avoid sounding authoritarian, but it's the rare parent who can get all of the necessary information and be an equal participant in these discussions, he noted. "There are times, as physicians, that we have to take a strong stand and say what we believe," said Bromberg.
Opel suggested that parents need to understand that if their child's doctor asks them an open-ended question about vaccines, it's not because there's some alternative to immunizations, it's probably because they're trying to develop a relationship and engender trust.
"We don't want parents to leave with questions or concerns unanswered. Your child's doctor really is interested in talking to you about your vaccine concerns, but you should be prepared to hear your pediatrician out, too," said Opel.
Learn more about children's vaccines from the Nemours Foundation (http://kidshealth.org/parent/general/body/vaccine.html ).
SOURCES: Douglas Opel, M.D., assistant professor, pediatrics, Seattle Children's Research Institute and the University of Washington School of Medicine, Seattle; Kenneth Bromberg, M.D., chair, pediatrics, and director, Vaccine Research Center, The Brooklyn Hospital Center, New York City; December 2013 Pediatrics