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

Debra Kane Hill, MBA, RN, Senior Patient Safety Risk Manager, The Doctors Company, Part of TDC Group

Updated January 3, 2022: As Omicron variant cases sweep alarmingly across the United States, more individuals are considering vaccination against COVID-19. 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 the 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.

Throughout the rollout, not everyone has been eager for a vaccination. Some reasons for continued vaccine hesitancy include:

• Concern about potential vaccine side effects.
• Safety concerns and questions about effectiveness.
• Distrust of the government or political positions.
• Personal freedom.
• Religious beliefs.
• Preference for natural or herd immunity.
• The rush to push the vaccine to market with the perspective that it is “too new.”
• Not seeing oneself as being "high risk".
• Concerns about the long-term effects in children.

Although mixed perspectives about willingness to accept the vaccine persist, it appears now that more individuals are reconsidering their decision. According to the CDC's COVID Data Tracker, vaccination numbers have skyrocketed in recent weeks due to concerns about the Delta and Omicron variants as well as workplace mandates, assurance regarding safety of the vaccine, and the persuasion of family and friends.

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 clinician is pro-vaccine but some staff are vaccine hesitant, the clinician 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 for asking questions and expressing concerns, and counter with facts and without argument.
• 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 (generally 6^th grade level).
• 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 or the booster 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. Clinicians 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 or booster. 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, the vaccines have 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 and side effects. For patients receiving the Pfizer and Moderna vaccines, stress the importance of receiving the second dose followed by a booster 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, particularly due to the rise in Omicron.
• 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 next 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 fact sheets are available through the Food and Drug Administration (FDA) website: Pfizer-BioNTech—Fact Sheet for Recipients and Caregivers, Moderna—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.
• Avoid Misinformation. The Federation of State Medical Boards released the following warning: “Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded and consensus-driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.”
• 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 Vaccine Recipient Education, including Talking with Patients about COVID-19 Vaccination.

Understanding and acknowledging patient perspectives about the vaccine play a principal role in promoting vaccination compliance. Frontline clinicians 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.