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 immunisations, 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 paediatrician, but that conversation doesn't always go
well," said study author Dr Douglas Opel, an assistant professor of paediatrics
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.
Childhood vaccination rates
Rates of some childhood
vaccinations in the United States are below the 80% 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 non-medical 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 and in the December print issue of the journal Paediatrics, Opel
and his colleagues analysed 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% –
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% of the
initially resistant parents chose to follow that recommendation.
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 Centre and chairman of paediatrics
at the Brooklyn Hospital Centre 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.
Paediatricians 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
immunisations, 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 paediatrician out, too," said Opel.
Learn more about children's
vaccines from the Nemours