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Communicating with COVID-19 Vaccine-Hesitant Patients: Top Tips

Debra Kane Hill, MBA, RN, Senior Patient Safety Risk Manager

Updated April 28, 2021: As the COVID-19 vaccine rollout continues across the United States, it is important for physicians to be prepared to answer questions from patients about the various vaccines—particularly since some patients remain hesitant about receiving a vaccination. A good strategy includes implementing a practice plan to educate patients and guide them to an informed decision about the vaccines available within their community.

In the early phases of the rollout, accessing a vaccine was very difficult, and frustration was rampant. There were limited supplies, ineffective scheduling systems, and poor communication; long waiting lists and lines were the norm. In addition, not everyone was eager for a vaccination. A Kaiser Family Foundation survey in December 2020 revealed several reasons for vaccine hesitancy:

  • 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.”

Although mixed perspectives about willingness to accept the vaccine persist, it now appears that more individuals are reconsidering the decision. JAMA’s “National Trends in the US Public’s Likelihood of Getting a COVID-19 Vaccine—April 1 to December 8, 2020” stated the self-reported likelihood of getting the vaccine was 56 percent in early December 2020, meaning 44 percent were not likely to get the vaccine. In February 2021, the CDC reported non-intent had declined to 32.1 percent.

Since many remain 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 but some staff are vaccine hesitant, the physician/practice owner should ensure that patient messaging is consistent with the defined pro-vaccine culture of the practice.
  • Conduct a deliberate discussion. Whether the patient is receiving the vaccine in your office or at another site, educate your patients on what to expect and the consequences of non-vaccination. For patients receiving the vaccine in your office, conduct a thorough informed consent discussion using language the patient can understand.
  • 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 and language access. Communicate using everyday language, and provide language services if necessary. Tailor written education materials to a reading level appropriate for most patients.
  • Use established communication tools. To ensure patients have a clear understanding of health instructions, use 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 get the second dose of the vaccine.” This provides 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 resource.
  • 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 while none of the vaccines are 100 percent effective, each vaccine has proven efficacious in protecting against severe illness and death and substantially contributes to lessening the spread of the virus. For patients concerned that the Janssen (Johnson and Johnson) vaccine is sub-standard to the other vaccines, provide information about the differences between the vaccines including efficacy, side effects, and expected outcomes while emphasizing to patients that gaining access to any vaccine is the top consideration, based on current limited resources. For patients receiving the Pfizer and Moderna vaccines, stress the importance of receiving the second dose to optimize their protection. Emphasize the need to continue wearing masks, social distancing, and practicing good hand hygiene even after getting the vaccine until the CDC recommends differently.
  • 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 with 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 CaregiversModerna—Fact Sheet for Recipients and Caregivers, and Janssen (Johnson and Johnson)--Fact Sheet for Recipients and Caregivers. The Centers for Disease Control and Prevention (CDC) also provides easy-to-understand fact sheets for patients on its website: Benefits of Getting a COVID-19 Vaccine and Facts about COVID-19 Vaccines.
  • Document the informed consent discussion. If giving the vaccine in your office, 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 play 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 healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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