Advancing the Science

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April 18, 2021

Experts propose shared decision making to decrease COVID-19 vaccine hesitancy

By Adam Harringa

The COVID-19 pandemic has lasted more than a year, but hope is here in the form of multiple safe and effective vaccines authorized for emergency use. Millions are now being vaccinated, but as vaccine supply continues to increase throughout 2021, a hurdle health experts anticipate eventually is a lack of public demand. That is, how do health care providers address vaccine hesitancy when it’s critical for the greater good that enough of the population is vaccinated to reach herd immunity?

To Greg Poland, M.D., an infectious diseases expert and head of Mayo Clinic’s Vaccine Research Group, the answer comes down to one word: Listening.

Dr. Greg Poland, an infectious diseases expert at Mayo Clinic.
Dr. Greg Poland, an infectious diseases expert at Mayo Clinic.

“In the spirit of seeking the root-cause issue, we need to stop asking why people don’t understand what we are telling them and consider asking why we don’t understand them,” Dr. Poland and colleagues write in a recent editorial in the scientific journal Vaccine. “For many patients, health care providers are no longer considered to be the exclusive expert in health decisions.”

In the article, the authors break down possible paths forward for health care providers and their patients:

  • Why is a patient reluctant? Patients can be hesitant to get vaccinated for a variety of reasons, the authors say. Health care providers should start by listening to their concerns in an empathetic, non-judgmental way, rather than proposing solutions immediately. Some patients may have concerns about safety or efficacy, while others could be concerned about convenience or pain, for example. “The point isn’t to abandon science,” they write, but to develop trust and “help people make evidence-based decisions.”
  • What are patients’ core beliefs? A core attribute of humans is a desire to defend their core beliefs, the authors say. So if new information conflicts with these beliefs, it’s often hard to persuade them, despite scientific evidence to the contrary. During a traumatic event such as a pandemic, some people may rely on emotion-based decision making. But if health care providers can include patients in the decision-making process, this can begin to break down barriers and address any biases, cognitive distortions, misinformation or core fears. This is also known as the human-centered design method, where the health expert “seeks to empathize with and understand peoples’ unspoken and often unrealized motivations” to create a solution founded in the patient’s specific values.
  • Who and what influence patients’ decisions? To facilitate a human-centered design method, the authors developed a vaccine decision making empathy tool for health care providers to complete with patients. The tool asks for patients’ values and concerns, along with who and what are major, moderate and minor influences. Then the provider plots these influences on the map, and asks how these influences make the patient feel, and how they affect his or her choice. This can help providers embrace each patient’s thought process rather than dismiss it.
  • Keep at it. Patients may not respond to the first discussion. The empathy tool is intended to be used multiple times, if necessary, over time with an individual patient. Then the patient and health care provider can see together how beliefs change over time.

Dr. Poland, who is Editor-in-Chief of Vaccine, wrote the editorial with his daughter Caroline Poland, a licensed mental health counselor and certified clinical trauma professional with Poland and Associates Consulting, along with Allison Matthews, a designer in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

The research was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The mission of the center is to be an innovative driver of change for Mayo Clinic by developing, analyzing and rapidly diffusing solutions for the transformation of health care.

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Dr. Poland is a paid scientific advisor for Johnson & Johnson/Janssen Global Services LLC. Dr. Poland is the chair of a Safety Evaluation Committee for novel investigational vaccine trials being conducted by Merck Research Laboratories. Dr. Poland offers consultative advice on vaccine development to Merck & Co., Medicago, GlaxoSmithKline, Sanofi Pasteur, Emergent Biosolutions, Dynavax, Genentech, Eli Lilly and Company, Kentucky Bioprocessing, Bavarian Nordic, AstraZeneca, Exelixis, Regeneron, Janssen, Vyriad, Moderna, and Genevant Sciences, Inc. Dr. Poland holds patents related to vaccinia, influenza, and measles peptide vaccines. Dr. Poland has received grant funding from ICW Ventures for preclinical studies on a peptide-based COVID-19 vaccine. These activities have been reviewed by the Mayo Clinic Conflict of Interest Review Board and are conducted in compliance with Mayo Clinic Conflict of Interest policies. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and was conducted in compliance with Mayo Clinic Conflict of Interest policies.

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Tags: COVID-19, Education, Gregory Poland, infectious disease, News, shared decision making, vaccine hesitancy, vaccines

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