Supporting Patient Autonomy in Vaccine Conversations

Developed in partnership with the Our Partner

In “Beyond Diagnosis: Vaccines,“ Cleveland Clinic infectious disease specialist Donald Dumford III, MD, and host John Mangels continue their conversations on communicating effectively and empathetically with patients around vaccination decisions.

Each monthly installment has examined an individual aspect of these crucial discussions, including building trust, addressing misinformation, and navigating emotionally and culturally influenced concerns.

In this final episode, Dumford reflects on the importance of patient autonomy, revisiting difficult conversations over time, and helping patients make informed decisions through empathy, trust, and active listening.

The following is a transcript of their remarks:

Mangels: Welcome to “Beyond Diagnosis,” where we talk with doctors about talking with patients. I’m your host, John Mangels.

Today, we’re exploring one of the more challenging topics that clinicians face: speaking with patients about vaccinations.

Our guest is Cleveland Clinic infectious disease specialist Dr. Donald Dumford. He spends a lot of time navigating these dialogues: listening, building trust, and helping patients understand their choices. Dr. Dumford, thanks for being here.

Dumford: Thanks so much for having me.

Mangels: Preserving a patient’s sense of autonomy is important, I’m sure, in vaccine conversations. How do you handle situations where a patient isn’t ready at the time of the appointment to make a decision about being vaccinated?

Dumford: Well, I think it’s helpful to let them know that they can come back for those vaccines, whether it’s those cases where you recommend multiple things at once and they feel like, “Oh gosh, I just really want to stagger this,” or if they just need time to think about it. I think it’s allowing that to happen so they know that they’re in the driver’s seat of this, they’re the ones making the decision, really helps them out to probably adhere to what you’re trying to help them to understand and just gives them time to process.

Mangels: Depending on the vaccine, you don’t want them to wait too long to make that decision, but giving a little bit of time to sort of rest and reflect sounds like it might be effective.

Dumford: Yeah, I found that to be very effective. And I’ll even let people know if we’re talking about, especially the timely ones, we’re talking about influenza vaccine, COVID vaccine, and if we’re talking about it as we’re starting to get into the respiratory virus season, I’ll let them know we don’t have to make a decision today, but I expect that cases are going to start to go up around this time so that we can let them know, “Hey, here’s kind of the time where we have to make that decision by so that your body has plenty of time to be protected when we really start to see a lot of cases.”

Mangels: What information or resources do you suggest to patients to help them make up their minds?

Dumford: Going to kind of those reliable resources, especially CDC, is very helpful. Sometimes some local and state health departments. I think the Cleveland Clinic has a lot of very worthwhile resources to help with patient understanding. I think other places such as JAMA, New England Journal [of Medicine], and UpToDate all have some very good patient resources.

Mangels: Can you think of an example in your own practice where giving patients a little space led to the outcome that you wanted?

Dumford: I see that actually pretty frequently. When we think about COVID and flu vaccine, I do give that space and let them know, “Hey, we’re not seeing a lot of cases now, but you’ve got this, this, and this condition. They’re putting you at increased risk. I really think this would be in your best interest. This is what I would be doing for myself or a family member, but the ball’s in your court, you’re in control of this, but let me know in like a week if you want to come back and do that.”

I’ve also found that to be the case — maybe not with the more timely vaccines — when we’re talking about things like hepatitis B vaccine, give them the information, let them know, and then give them the time to make that decision.

Mangels: How do you convey to a patient that really the final decision does lie with them while still maintaining your professional integrity and feeling like you’re upholding your oath?

Dumford: While we’re kind of upholding that Hippocratic Oath while also thinking about patient autonomy, I know that if I’ve given them the information, if I’ve done my counseling, even if they don’t make the decision I think is in their best interests, I at least feel like I’ve done my job, and hopefully have told them enough to actually have them well enough informed.

Mangels: Do you ever take another bite at the apple later? I mean, with a patient who said, “I just don’t want to do that,” do you revisit that at some point?

Dumford: All the time. So, I’ll kind of come back to it when I look at my list of things that are due and I’ll say, “Oh, so we talked about this last year, but it’s still time for your tetanus vaccine,” which tetanus also has diphtheria and pertussis in it. And I’ll remind them and be like, “Hey, this is what happens with this, this is what happens with this bacteria, this is what happens with whooping cough,” and just kind of remind them and that we can really prevent some potentially severe outcomes. But I think it is just really revisiting those conversations [that] really helps.

Mangels: And conveying that you’re asking because you care about them. You’re going to nag them because you want the best for them.

Dumford: Exactly. I’d say I think reminding them that you have their best interests at top of mind is really important.

Mangels: If you were going to give one piece of advice to your peers, your colleagues, whether in primary care or infectious disease, about talking to patients who feel hesitant or overwhelmed or uncertain about vaccinations, what would that advice be?

Dumford: I think it’s really just truly listening and hearing where they’re coming from. I think just the impact of knowing that you’re being empathetic to them and you’re listening to what they have to say really establishes that rapport and that trust, and I think that really helps with the vaccine conversations.

Mangels: Just work on conveying your empathy and your compassion and the fact that you care for the patient.

Dumford: Exactly. Taking a deep breath and just being present in the conversation really helps.

Mangels: Thanks so much for your insights, Dr. Dumford. And thank you for joining us on “Beyond Diagnosis,” where we explore not just what physicians know, but how to effectively and compassionately share that knowledge with patients. See you next time.

Please enable JavaScript to view the comments powered by Disqus.