Avoiding the COVID Shot Talk? Here’s What to Do

Do you hesitate to bring up COVID vaccines with your patients? You’re not alone — and experts said these conversations are becoming less common in routine care.

The reasons are complex, ranging from short visit times and shifting clinical priorities to the health attitudes of both physicians and patients — and something Arthur Caplan, PhD, head of the Ethics Division at NYU Grossman School of Medicine, New York City, called “COVID exhaustion.”

“There is a feeling that everybody who’s going to get COVID either got it or got vaccinated or doesn’t want [the shot],” said Caplan.

But your silence can leave patients feeling unsure about what to do. New CDC guidance for COVID boosters — and even baseline vaccination — for healthy people (including children) has shifted toward shared clinical decision-making.

What does that mean? According to the now-fired CDC vaccine advisory panel, shared clinical decision-making means “informed by the best available evidence of who may benefit from vaccination; the individual’s characteristics, values, and preferences; the healthcare provider’s clinical discretion; and the characteristics of the vaccine being considered.”

The panel added, “There is not a prescribed set of considerations or decision points in the decision-making process.” In other words, you’re on your own.

All the major US physician organizations still recommend the shots for everyone 6 months and older. Amid widespread misinformation about the vaccines’ risks and lack of benefit, there’s another reason providers should bring them up — protecting those most at risk for severe COVID, Caplan said.

“We’re so individualistic, so focused on personal choice, so focused on the individual, that we’re undercutting a moral basis or the ethical basis for vaccination, which is the community,” he said.

Surveys consistently showed that more people say they plan to get COVID vaccines than actually do, and the barriers throttling that conversion rate are unclear. If you find yourself hesitating to bring up the COVID vaccine, ask yourself why — so you can thoughtfully address that hesitation in practice.

Why You Don’t Bring Up COVID Shots With Healthy Patients

First, the elephant in the room: Many people are hesitant to talk about COVID vaccines because of how politically charged the topic has become, and clinicians are no exception. 

“Physicians may be hesitant to bring up any topics that might induce partisan beliefs and lead people to be less trusting of seeking out medical care,” said Timothy Callaghan, PhD, associate professor at the Boston University School of Public Health, Boston, and an expert in vaccine hesitancy and health behavior. “They might forego discussing those to make sure they’re doing everything they can to keep patients engaged with the healthcare system so that they can keep them safe and healthy.”

Another key challenge is the topic’s complexity. “Sometimes those conversations need to be lengthy to let people feel comfortable that their questions were answered, their fears were addressed, the confusion was resolved,” said Jen Brull, MD, president of the American Academy of Family Physicians. “In a 10- or 15-minute office visit, you might say, ‘Do I want to open this Pandora’s box today? Do I have time to do this? How late am I?’”

In the pediatric setting, parents’ perception is often that COVID is generally well-tolerated by healthy children, and they view COVID vaccines differently than they do vaccines that are required for school, said Jesse Hackell, MD, chair of the American Academy of Pediatrics Committee on Pediatric Workforce.

“If I’ve got a kid who needs the measles vaccine and the COVID vaccine, I don’t want to poison the atmosphere for the measles vaccine by pushing the COVID vaccine,” Hackell said.

Your move? Don’t wait for the Pandora’s box moment. Start preparing now.

Your Vaccine Recommendation Plan

You may not be thinking about your fall vaccine campaign yet, but now is the time to plan — before an unexpected surge leaves you unprepared.

One exception to fall timing is baseline vaccination of 6-month-olds, Hackell said. Data show the risk for severe illness during the first year is high, so these babies should get vaccinated “as soon as possible.”

Otherwise, here are some ways to incorporate COVID vaccine recommendations both in and outside the clinic:

• Post signs. Visual and contextual nudges in clinical workflow have been shown in studies to increase uptake, said Brull. “In our clinic, we had success using rotating signs that highlight different patient motivations like ‘I got vaccinated so I can visit my grandkids’ or ‘Protect your community, one shot at a time.’” Variety increases the odds patients will see themselves.
• Make it routine. Hand out vaccine consent forms at check-in or during the nurse portion of the visit. This normalizes the vaccine as routine and gives patients more review time, so they’re more likely to consent.
• Don’t single it out. Add the COVID vaccine handout to the clipboard with the Patient Health Questionnaire-9. Bundling forms “lowers defensiveness by removing the ‘special issue’ spotlight and opens the door for a low-stakes conversation,” Brull said. “Patients often assume that if it’s on the clipboard, it must be important and expected.” And it’s an easy in: “I saw you marked ‘not yet’ on the COVID vaccine — can we talk about that?”
• Recruit help. Train staff to approach vaccine talks with curiosity and warmth, not pressure. Offer suggested phrases like “Have you had a chance to get your COVID shot this season?” “Any questions about the vaccine? I can help.” “A lot of patients are wondering about boosters — want me to flag it for the doctor?”
• Emphasize a team approach. Initiate the handoff to your staff with something like “Let me know what they say; we’ll tag-team it.” Remember, your team may have hesitancy, too. Normalize this: “It’s okay if patients aren’t sure. Just open the door to the conversation.”
• Lead with empathy. The consent form and nurse discussion provide intel before you even enter the exam room. “If the nurse noted, ‘Patient is nervous because they felt tired after the last booster,’ I can open with empathy: ‘I saw you had a rough time after the last one. It’s totally understandable to be cautious. Let’s talk through what’s different this time,’” Brull said.
• Be curious. A common opener Brull uses is, “Since you’re here, I want to make sure you’re up to date on all your vaccines, including COVID. Are you open to getting it today?” Or, if there’s hesitation: “Tell me what you’re thinking; I’d love to understand where you’re at with it.”
• Use technology. Recommending vaccines via text, patient portal, or email meets patients where they are — on their phones. Try subject lines like “You’re eligible — COVID vaccine now available at your clinic” or “Protect yourself this season — schedule your booster today.” In the message, give an action step: “We’re offering updated COVID vaccines now — call or click to schedule. Vaccination is quick, safe, and helps keep our community healthy. Questions? Just reply — we’re here.”