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Talking to Parents about Vaccine Concerns

Talking to Parents about Vaccine Concerns. Ari Brown, MD, FAAP Julie Boom, MD, FAAP.

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Talking to Parents about Vaccine Concerns

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  1. Talking to Parents about Vaccine Concerns • Ari Brown, MD, FAAP • Julie Boom, MD, FAAP

  2. We do not have a significant financial relationship with the manufacturers of commercial products and/or providers of commercial services discussed in this CME activity.We do not intend to discuss an unapproved/ off-label use of a commercial product/device in my presentation.

  3. GREETINGS FROM AUSTIN

  4. OVERVIEW • How did we get here....and who is to blame? • How do parents approach decisions? • Are we done yet? • What are we doing about it? • Risk Communications 101. • How to answer the top vaccine questions.

  5. Noun: A place where people validate their beliefs

  6. Anecdote vs Science

  7. 80% OF PEOPLE SEARCH WITHOUT CHECKING THE SOURCE

  8. MEDIA, MOM, & MAVERICK 1998-2010

  9. THE DEMISE OF WAKEFIELD2010 • 30 counts of medical misconduct. • Loss of medical license. • Lancet retracts 1998 study. • Resignation from Thoughtful House.

  10. Mickey gets Measles2015

  11. ARE WE TO BLAME?How much time do we talk about shots?

  12. How did we get here....and who is to blame? How do parents approach decisions? Are we done yet? What are we doing about it? Risk Communications 101. How to answer the top vaccine questions. OVERVIEW

  13. PARENT PARANOIA

  14. GREATER GOOD VS. INDIVIDUAL RIGHTS Societal Benefit does not influence parental decision making. Pediatrics, Sept 2014

  15. VACCINE ATTITUDES • Believers • Relaxed • Cautious • Unconvinced —Benin AL, etal. Analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics 117(5) 2006.

  16. VACCINATORS • #1: Trust their healthcare provider. • Feel satisfied with the discussion. • Feel that it is the right thing to do. • Want to prevent disease.

  17. Patients trust you!

  18. NON-VACCINATORS • Feel alienated by their healthcare provider. • Distrust motives. • Trust a homeopath or naturopath. • Perceive risk of vaccine more than disease risk. • Deliver at home, with a midwife, and reject Vitamin K shots. (Pediatrics, Sept 2014) • Perceive others will protect them.

  19. How did we get here....and who is to blame? How do parents approach decisions? Are we done yet? What are we doing about it? Risk Communications 101. How to answer the top vaccine questions. OVERVIEW

  20. 2016

  21. De Niro replaces McCarthy

  22. Wakefield 2017…he’s baaack.

  23. Philosophical and Religious exemption laws

  24. California: Post-philosophical exemption law

  25. Texas public schools: exemption rates

  26. Texas private schools

  27. birds of a feather

  28. We are not done...But we are doing pretty well. <1% of American kids ages 19-35 months are unvaccinated. MMWR Report, Nov 2017.

  29. Tdap: 87%, Meningococcus: 79% HPV: 60% of girls & 50% boys start series All 3 HPV: 40% girls, 21% boys MMWR 8/26/16

  30. How did we get here....and who is to blame? How do parents approach decisions? Are we done yet? What are we doing about it? Risk Communications 101. How to answer the top vaccine questions. OVERVIEW

  31. American Academy of Pediatrics, Sept 2016

  32. How did we get here....and who is to blame? How do parents approach decisions? Are we done yet? What are we doing about it? Risk Communications 101. How to answer the top vaccine questions. OVERVIEW

  33. Pro-vaccine messaging backfiresNyhan B, Pediatrics March 2014 1. MMR scare was a hoax. 2. Information about vax-preventable diseases. 3. Pictures of vax-preventable diseases. 4. A mother’s story of when her child got measles.

  34. WHAT YOU SAY • I VACCINATED MY OWN KIDS... • I GET THE FLU VACCINE EVERY YEAR... • I WOULDN’T ADVISE ANYTHING DIFFERENTLY FOR YOUR FAMILY. PUBLIC OPINION SURVEY 2008

  35. HOW YOU SAY IT • THEY WANT TO BE HEARD. • THEY WANT TO BE RESPECTED. THEY ARE TRYING TO DO WHAT IS IN THE BEST INTEREST OF THEIR FAMILY. • THEY WANT AN EXPLANATION FROM A PERSON THEY TRUST. • THEY DON’T WANT SCARE TACTICS. • THEY DON’T WANT TO BE SCOLDED.

  36. These are not BAD parents.They are SCARED parents.

  37. Speak with CONVICTION.Presumptive style: “Well he’s due for some shots today.”Participatory style: “What would you like to do about shots?”Opel DJ, Pediatrics Nov 2013

  38. Nonverbal Communication

  39. GREAT COMMUNICATORS • KNOW THEIR AUDIENCE. • TALK WITH THEM...NOT TO THEM. • CARE. • DON’T ARGUE. • FIND COMMON GROUND. • LISTEN. • SPEAK SUCCINCTLY, WITH PASSION & COMPASSION.

  40. How did we get here....and who is to blame? How do parents approach decisions? Are we done yet? What are we doing about it? Risk Communications 101. Practice using the CASE method. OVERVIEW

  41. Use the “CASE” model Corroborate About me Science Explain/advise Singer A. Autism Science Foundation. Texas Immunization Summit. www.immunizeusa.org/2010-summit-update/ Jacobsen R. et al. The C.A.S.E. approach: guidance for talking to vaccine-hesitant parents. Minn Medicine: 49-50.

  42. So, how do you corroborate? • Carefully! Say, “ I have heard that concern from other parents.” Say, “ That is a common story that people often share.” Don’t say “Oh, I understand why you would think that.” Don’t say “You’re right. Many people believe that.” • Don’t accidentally confirm their concern as accurate information Singer A. Autism Science Foundation. Texas Immunization Summit. www.immunizeusa.org/2010-summit-update/ Boom JA, Cunningham RM (2014). Understanding and Managing Vaccine Concerns.

  43. What do I say about me? • Remember: you are the most important influence in a parent’s health care decision • Explain your background, time and effort spent reviewing scientific materials, knowledge gained through study and experience • Say, “I just attended a medical conference and heard an expert, Dr. Ari Brown, author of Baby411, speak on this very topic. She explained…..” • Purpose: not to brag, but to reassure the parent of your credibility

  44. What science do I share? • Keep it relevant to the concerns voiced by the parent • Offer information at the educational level of the parent • Stay current • Be confident and clear • Use Vaccine Information Statements and other written and internet resources

  45. Tips for explaining/advising • This is your best chance to advise the parent on the best choice for their child • Recognize that the choice will always be theirs, but you are interested in helping them in their efforts • Translate the science into advice • Again, be confident and directive, but not polarizing

  46. Practicing the CASE Method

  47. Concern: My nephew has autism and I’m worried that vaccinating my baby will make him autistic too.

  48. CAUSES OF AUTISM • Genetics • Mature parents • Closely spaced pregnancy • Extreme prematurity • Medications in pregnancy • Obesity in pregnancy • Maternal diabetes • Folic acid in pregnancy

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