As California's measles outbreak continues to spread beyond state borders, many doctors nationwide are grappling with how best to convince parents to have their children vaccinated. Inviting a collaborative conversation doesn't work all that well, many are finding. Recent research suggests that being more matter-of-fact can work a lot better.
Pediatrician Eric Ball, who practices in southern California, says, in his experience, the families skeptical of vaccines can be divided into two types.
"There are people who believe in grand conspiracies — that the whole medical community is trying to make money at the expense of their child," he says. "They don't really believe in science. They don't believe in data, and no amount of discussion is going to really convince them."
Ball says he sees other skeptical parents who are on the fence, and he works really hard, using a collaborative approach, to convince these parents that vaccines are safe and effective.
"We try to assess what their fears are," he says, "why they're not vaccinating — what they've read, what they've heard. And then we try to dispel myths."
But some surprising research by Dr. Doug Opel, a pediatrician at Seattle Children's Hospital and a researcher at the University of Washington, suggests Ball might want to try a less collaborative approach.
In the study Opel and colleagues described in the December issue of Pediatrics, they enrolled 111 parents, some hesitant about vaccines and some not.
He videotaped the parents talking with their doctor about vaccines during a routine well-child visit. The doctors, he noticed, handled the conversation in one of two ways.
The first, Opel calls "presumptive."
"The doctor," he noticed, "just simply presumed that the parent was going to be fine with the vaccines that the doctor was going to recommend," saying something like " 'So, Johnnie's due for DTaP and Hib today' – period. Move on."
Some other doctors, Opel observed, invited parents to discuss their feelings about vaccines — "sort of invoking a shared decision-making approach, inviting the parent to be part of this conversation." These doctors, he says, were more likely to ask, " 'So, Mom: What do you want to do about vaccines today?' "
The study's surprising results: When doctors assumed parents would be OK with vaccines, they were. More than 70 percent had their child vaccinated.
On the other hand, when physicians were more flexible and allowed for discussion, most of the parents — 83 percent — decided against vaccination.
"It was quite a difference," Opel says, "just based on how the doctor began the conversation."
When it comes to public health, he says, "shared decision making" doesn't make sense."There's an incredible amount of robust evidence that is behind the recommended immunization schedule."
SCOTT SIMON, HOST:
More than a hundred people in 14 states have now gotten sick with measles. Most of those infections are linked to the recent outbreak in California. Health officials say the majority of those infected were not vaccinated. As NPR's Patti Neighmond reports, doctors are trying to figure out the best way to approach parents who are hesitant to have their children vaccinated.
PATTI NEIGHMOND, BYLINE: Pediatrician Eric Ball, who practices in Southern California, says families skeptical of vaccines can be divided into two different types.
DR. ERIC BALL: There are people who believe in grand conspiracies and that the whole medical community is, you know, trying to make money at the expense of their child, and they don't really believe in science. They don't believe in data, and no amount of discussion is going to really going to convince them.
NEIGHMOND: But parents who are on the fence, Ball says he works really hard to convince them vaccines are safe and highly effective.
BALL: We try to assess what their fears are, why they're not vaccinating, what they've read, what they've heard, and then we try to dispel myths that they have heard on social media or at the playground from other parents.
NEIGHMOND: Inevitably, Ball says, there are anecdotal stories about a cousin or a friend of a friend's child who had a bad reaction to a vaccine.
BALL: And it's important for us to tell them about the science behind that and try to convince them that these vaccines are very safe, they're very effective, and they save lives.
NEIGHMOND: In Seattle, Pediatrician Doug Opel, of the University of Washington, wanted to know the most effective approach to convince hesitant parents. So he enrolled more than a hundred parents in a study and videotaped them during a routine well-child visit. He observed two different doctor approaches toward vaccines - one he calls presumptive.
DR. DOUG OPEL: The doctor sort of just simply presumed that the parent was going to be fine with the vaccines that the doctor was going to recommend and sort of said that and moved on. So Johnny's due for IPV, DTap and Hib today - period, move on.
NEIGHMOND: Then there was the more open-ended approach.
OPEL: Sort of invoking a shared decision-making approach, inviting the parent to be a part of this conversation. So, Mom, what do you want to do about vaccines today?
NEIGHMOND: Now, here's the surprising part. When doctors assumed parents would be OK with vaccines, they were. Over 70 percent had the child vaccinated. But when doctors allowed for discussion, most parents - 83 percent - decided against vaccination.
OPEL: Quite a difference just based on how the doctor began the conversation.
NEIGHMOND: Opel says when it comes to public health, this kind of shared decision-making doesn't make sense.
OPEL: There's an incredible amount of robust evidence that is behind the recommended immunization schedule.
NEIGHMOND: In terms of effectiveness, safety and timing of vaccines. Some parents don't think issue with individual vaccines, but they do worry about the number of vaccines recommended - Dr. Mobeen Rathore, with the American Academy of Pediatrics.
DR. MOBEEN RATHORE: Our bodies are exposed to all sorts of things in nature all the time, and there's really no danger, no harm, to the body when they get the vaccines, and the body's able to handle those vaccines just fine.
NEIGHMOND: Pediatrician Ed Marcuse, of the University of Washington, says doctors need to learn more about how best to communicate.
DR. ED MARCUSE: When you have outbreaks that ultimately stem from parents deciding not to vaccinate their child because of poor information or misinformation about vaccine safety and efficacy, it cries out for funding to study how best to inform parents.
NEIGHMOND: Marcuse says the latest measles outbreak may spark such funding. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.