Debra Kane Hill, MBA, RN, Senior Patient Safety Risk Manager
As the early phase of the COVID-19 vaccine rollout occurs across the United States, physicians should proactively prepare for the upcoming administration of vaccines to the general population. This includes implementing a plan to initiate effective informed consent conversations with patients to guide them to an informed decision about the vaccine.
Senior citizens in Florida waited hours in line when vaccines were initially available, and these long waits were caused by offering shots on a first-come, first-served basis rather than through organized registration. In addition, not everyone is eager for a vaccination. A Kaiser Family Foundation survey in early December 2020 revealed that over a quarter of the American population has strong reservations about receiving the COVID-19 vaccine, should it be made freely available to them. Reasons cited in the study for vaccine hesitancy include:
- Potential vaccine side effects.
- Safety concerns and questions about effectiveness.
- Distrust of the government or political positions.
- The rush to push the vaccine to market with the perspective that it is “too new.”
The good news is that compared to previous studies conducted in September by Kaiser and ESPN, willingness to receive the vaccine has improved from 63 percent to 71 percent. However, JAMA’s National Trends in the US Public’s Likelihood of Getting a COVID-19 Vaccine—April 1 to December 8, 2020 reported a downward trend in which the self-reported likelihood of getting the vaccine declined from 74 percent in early April to 56 percent in early December 2020.
Since many are hesitant about the COVID-19 vaccine, these tips can help optimize important conversations with patients:
- Define your practice culture. For example, how will all staff members contribute to delivering the COVID-19 vaccine message to patients? If the physician is pro-vaccine, yet there are staff who are vaccine hesitant, the physician/practice owner should ensure that messaging to patients is consistent with the defined pro-vaccine culture of the practice.
- Conduct a deliberate discussion. Conduct a thorough informed consent discussion using language the patient can understand. Include information on the consequences of non-vaccination.
- Listen carefully to concerns. Encourage your patients to ask questions and express their fears and concerns. Be empathetic and acknowledge that it is reasonable to have concerns. Provide positive feedback when they do, and counter with facts and without argument. Avoid any disparaging remarks.
- Consider health literacy levels. Communicate in the patient’s preferred language at an educational level that the patient can understand. Written materials should be at a fourth- to sixth-grade reading level. Use interpreters, if necessary.
- Use established communication tools. To ensure patients have a clear understanding of health instructions, utilize communication tools such as Ask Me 3. Also consider the teach-back method. Rather than asking the patient, “Do you have any questions?” tell the patient, “Explain to me why it is important for you to come back and get the second dose of the vaccine.” This provides you an opportunity to assess the patient’s understanding of their need for the follow-up visit.
- Watch your words. A recent poll found that those communicating about COVID-19 need to remove politics and partisanship, and instead, remind people that taking steps to prevent the spread of the virus is good for those they love, for the economy, and for a faster return to a more normal life. Physicians may find the Changing the COVID Conversation: Communications Cheat Sheet published by the de Beaumont Foundation a valuable source.
- Set realistic expectations about potential side effects. Explain to patients that they may experience a normal response of sore injection site, low-grade fever, body aches, lethargy, headaches, and other symptoms, so they will not be fearful to return for the second dose. The CDC’s What to Expect after Getting a COVID-19 Vaccine provides factual post-vaccine information for patients.
- Remind patients that the vaccine is not 100 percent effective. Let patients know that receiving the second dose will optimize their protection. Emphasize that they will need to continue wearing masks, social distancing, and practicing good hand hygiene even after getting the vaccine.
- Recommend available apps. To help patients comply with the second dose of the vaccine, suggest the CDC smartphone app called V-safe After Vaccination Health Checker. This app sends reminders to patients when their second dose is due and provides them a way to report vaccine side effects.
- Provide factual vaccine information. Distribute materials well in advance of the scheduled vaccine appointment. Vaccine information sheets are available through the Food and Drug Administration (FDA) website: Pfizer-BioNTech—Fact Sheet for Recipients and Caregivers and Moderna—Fact Sheet for Recipients and Caregivers. The Centers for Disease Control and Prevention (CDC) also provides easy-to-understand fact sheets for patients on their website: Benefits of Getting a COVID-19 Vaccine and Facts about COVID-19 Vaccines.
- Document the informed consent discussion. Have the patient sign a COVID-19 vaccine informed consent form prior to the administration of the vaccine, and file it in the patient’s medical record. Document the discussion, including the provision of patient educational materials, the use of established communication tools, and patient engagement (including questions, concerns, and how those concerns were addressed).
- Take advantage of CDC resources. To promote patient compliance with the vaccine, the CDC provides communication resources for physicians on Talking to Recipients about COVID-19 Vaccines, including Answering Patients' Questions and Making a Strong Recommendation for COVID-19 Vaccination.
Understanding and acknowledging patient perspectives about the vaccine plays a principal role in promoting vaccination compliance. Frontline physicians should develop a plan for conducting candid conversations with their patients in a manner that is empathetic and supported by evidence, while emphasizing the overall benefits to the individual and society. Ultimately, however, it is up to the patient to make an informed decision about their immunization status.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.