Core Topic 6

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Core Topic 6

• Communicating with patients and parents

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Learning outcome

• To communicate effectively with patients and
  parents about vaccination

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Learning Objectives

• Direct others, including parents, to reliable
  sources of information both locally and
  nationally
• List the factors influencing parents/caregivers
  decision-making
• Communicate key facts in response to lay
  questions and correct misconceptions about
  vaccines
• Provide parents with language-appropriate vaccine
  information leaflets at a timely interval prior
  to vaccination and will be familiar with the
  content of the leaflets themselves
• Effectively communicate about risk associated
  with vaccination
• Demonstrate acknowledgement of the anxiety of
  individuals such as parents and respect differing
  views through listening to their concerns
• Demonstrate commitment to offering the best
  professional advice on vaccination

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What influences parents/patients in their
decision making about vaccination?

• Personal experience, attitudes and beliefs
• Knowledge of disease
• Family and friends
• Healthcare Professionals
• Media (newspapers, magazines, television,
  internet)
• In absence of disease, perceived threat of
  disease disappears and anxieties about vaccine
  safety increase
• Therefore vital that immunisers are able to
  respond to parental concerns and correct
  misconceptions about diseases and vaccines

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Communicating Risk

• Be open and honest about known adverse effects of
  vaccines
• Set risks into meaningful context
• e.g. compare risk from vaccine with risks from
  everyday activities
• Compare risks of vaccinating versus not
  vaccinating
• e.g. compare risk from vaccine with risk from
  disease

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Positive Messages

• How risks are perceived depends on how they are
  framed
• Risk communication that emphasises lives saved by
  vaccination may more effectively promote
  vaccination than discussing lives lost through
  not vaccinating
• Emphasise benefits of vaccines

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Effective Communication

• Make time to discuss vaccination and answer
  questions
• Be well-informed, confident, empathetic, open and
  honest
• Recognise factors affecting an individuals
  decision making and explore any specific concerns
• Communicate existing knowledge taking into
  account what individual already knows
• Provide written information leaflets and
  recommend other reliable sources of information

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Risk Communication - Summary

• Parents should be provided with all the facts and
  information they require to make an informed
  decision
• This includes
• the risks of the disease
• the benefits and risks of vaccinating
• the risks of not vaccinating
• In this way, they can make decisions that are in
  the best interests of the child

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Reassuring parents/patients

• Vaccine safety is taken extremely seriously
• Before being introduced, vaccines are rigorously
  trialled and have to pass strict regulations set
  by independent bodies
• Decisions about vaccine use are made following a
  detailed risk versus benefit analysis of all
  available information about the vaccine
• Once introduced, vaccines are carefully and
  continuously monitored
• Any suspected reaction is fully investigated by
  independent experts -often worldwide

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How do we know what parents think about vaccines?

• Since 1991, twice yearly tracking surveys
  undertaken by Department of Health
• These record mothers knowledge, attitudes and
  experiences of immunisation
• Also monitor recall and interpretation of
  Immunisation advertisements and information
  materials
• Knowing what parents think and understand enables
  the Immunisation Information team to produce
  materials aimed at right level and address
  concerns

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Surveys by the DH show that the public want

• Clarity
• Consistency
• Balanced and factual information
• Openness
• Healthcare professionals who are
• knowledgeable, confident, consistent and
  trustworthy
• Time and the opportunity to discuss their
  concerns
• Different routes to be used for delivering
  information

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Where do the public get information from?

• Healthcare professionals
• HVs primarily but midwives, GPs and PNs and
  other HCPs also influential
• Family, friends and spouse/partner
• Increasingly, partners are becoming involved in
  vaccine decision-making. Include them in your
  vaccination discussions where possible
• Leaflets
• Provision of up-to-date Immunisation Information
  published leaflets in parents/patients language
  therefore extremely important
• Advertising (TV most prominently)

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Practical ExerciseConsider how you will answer
the following commonly asked questions

• How do we know that vaccines are safe?
• What are the additives in vaccines and are they
  safe?
• Do vaccines overload the immune system?
• Isnt it better to acquire natural infection than
  be vaccinated?
• Why do we still vaccinate against these diseases
  when most of them have gone away?
• Isnt 8 weeks very young to receive so many
  vaccines?

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Sources of Immunisation Information

• www.immunisation.nhs.ukThe Immunisation team at
  the Department of Health produces this factual
  immunisation site for parents and health
  professionals
• It is a comprehensive, up-to-date and an accurate
  source of information on vaccines, disease and
  immunisation
• It has News and Hot Topics sections where
  current issues are rapidly responded to and
  clearly explained
• Fact sheets and information packs can be ordered
  and/or downloaded and translations are also
  available

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MMR Information

• www.mmrthefacts.nhs.uk is a website produced by
  the Department of Health Immunisation team
• It provides
• news
• information
• resources
• and scientific evidence
• specifically concerning the MMR vaccination

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Further reliable sources of vaccine information
www.ich.ucl.ac.uk/immunisation/This website is
designed for both parents and health
professionals. It includes a facility for asking
questions, a recent news section and useful links
to other websites
Vital signs, vital issues This booklet,
produced by the Meningitis Research Foundation
comprehensively addresses many common parental
concerns about vaccines in its QA section See
www.meningitis.org
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Sources of Vaccine and Disease Information

• Health Protection Agency www.hpa.org.uk
• Department of Health www.dh.gov.uk
• World Health Organisation www.who.int/en/ (lots
  of vaccine information in various sections)
• Royal College of Paediatrics and Child Health
  www.rcpch.ac.uk/ (Best Practice Statements for
  vaccinating immunocompromised children and
  injection technique)
• Institute of Medicine (IOM) of the National
  Academies www.iom.edu/ (extensive unbiased
  vaccine study reviews and evidence-based
  scientific advice)
• National Travel Health Network and Centre
  (NaTHNaC) www.nathnac.org (detailed up-to-date
  travel immunisation information)
• Vaccine product information http//emc.medicines.o
  rg.uk/ (for SPCs and PILs)

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Human Resources for Vaccine Information

• PCT Immunisation Lead
• Local Health Protection Unit (HPU)
• Consultant in Communicable Disease Control (CCDC)
• Vaccine Manufacturers
• Immunisation Department, HPA Centre for
  Infections
• 020 8200 7868

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• Minimum slide set created by
• Immunisation Department,
• Centre for Infections,
• Health Protection Agency
• to assist teaching of the Core Curriculum for
  Immunisation Training
• (see http//www.hpa.org.uk/infections/topics_az/va
  ccination/training_menu.htm)