Childhood vaccine risk/benefit communication in private practice office settings: A national survey

Communication about childhood vaccine risks and benefits has been legally r equired in pediatric health care for over a decade. However, little is know n about the actual practice of vaccine risk/benefit communication. Objectives. This study was conducted to identify current practices of child hood vaccine risk/benefit communication in private physician office setting s nationally. Specifically, we wanted to determine what written materials w ere given, by whom, and when; what information providers thought parents wa nted/needed to know, the content of nurse and doctor discussion with parent s, and the time spent on discussion. We also wanted to quantify barriers to vaccine risk/benefit discussion and to prioritize materials and disseminat ion methods preferred as solutions to these barriers. Methods. We conducted 32 focus groups in 6 cities, and then administered a 27-question cross-sectional mailed survey from March to September 1998, to a random national sample of physicians and their office nurses who immunize children in private practices. Eligible survey respondents were active fel lows of the American Academy of Pediatrics or American Academy of Family Ph ysicians in private practice who immunized children and a nurse from each p hysician's office. After 3 mailings, the response rate was 71%. Results. Sixty-nine percent of pediatricians and 72% of family physicians s elf-reported their offices gave parents the Centers for Disease Control and Prevention Vaccine Information Statement, while 62% and 58%, respectively, gave it with every dose. In similar to 70% of immunization visits, physici ans and nurses reported initiating discussion of the following: common side effects, when to call the clinic and the immunization schedule. However, p hysicians reported rarely initiating discussion regarding contraindications (< 50%) and the National Vaccine Injury Compensation Program (< 10%). Lack of time was considered the greatest barrier to vaccine risk/benefit commun ication. Nurses reported spending significantly more time discussing vaccin es with parents than pediatricians or family physicians (mean: 3.89 vs 9.20 and 3.08 minutes, respectively). Both physicians and nurses indicated an a dditional 60 to 90 seconds was needed to optimally discuss immunization wit h parents under current conditions. Stratified analysis indicated nurses pl ayed a vital role in immunization delivery and risk/benefit communication. To improve vaccine risk/benefit communication, 80% of all providers recomme nded a preimmunization booklet for parents and approximately one half recom mended a screening sheet for contraindications and poster for immunization reference. The learning method most highly endorsed by all providers was pr actical materials (80%). Other desirable learning methods varied significan tly by provider type. Conclusions. There was a mismatch between the legal mandate for Vaccine Inf ormation Statement distribution and the actual practice in private office s ettings. The majority of providers reported discussing some aspect of vacci ne communication but 40% indicated that they did not mention risks. Legal a nd professional guidelines for appropriate content and delivery of vaccine communication need to be clarified and to be made easily accessible for bus y private practitioners. Efforts to improve risk/benefit communication in p rivate practice should take into consideration the limited time available i n an office well-infant visit and should be aimed at both the nurse and phy sician.