Competency #6: Communication and Informed Consent

This competency communicates effectively about immunization, as relevant to the practice setting(s).

Learning Objectives

The health professional will be able to perform the following:

List the components of the evidence-based decision-making process.
Explain the importance of risk perception for immunization decision making.
Respond appropriately following an assessment of client knowledge, attitudes, and beliefs regarding immunization.
Deliver clear, concise messages about the risks of vaccine-preventable diseases and the benefits and risks of vaccines.
Provide appropriate evidence-based information and resources to clients regarding immunization and vaccines.
Provide guidance to clients so they can correctly identify credible sources of information on immunization and vaccines.
Apply, as appropriate to the practice setting, mass media strategies for public communication.

Introduction

Public concern regarding vaccine safety can reduce vaccine coverage and result in resurgence of vaccine-preventable diseases. As trusted information sources, health care providers have a vital role in the continued success of immunization programs. Providers must have skill and expertise, not only in the principles and practices of immunization but also in effective communications techniques. (Source: BCCDC)

What is Evidence-Informed Public Health?

The process of distilling and disseminating the best available evidence, whether from research or from actual practice, and using that evidence to inform and improve public health practice and policy. Put simply, it is finding, using and sharing what works in public health. (Source: National Collaborating Centre for Method and Tools)

Stages in Evidence-Informed Public Health

Define	Clearly define the question or problem
Search	Efficiently search for research evidence
Appraise	Critically and efficiently appraise the research sources
Synthesize	Interpret/ form recommendations for practice based on the literature found
Adapt	Adapt the information to a local context
Implement	Decide whether (and plan how) to implement the adapted evidence into practice or policy
Evaluate	Evaluate the effectiveness of implementation efforts

For more information, visit: http://www.nccmt.ca/eiph/index-eng.html

Principles of risk communication

The goal of effective risk communication is the development of an informed decision-making partnership. The process involves both education and advocacy. The process is facilitated through;

advance preparation by all participants
clear messaging,
an open and respectful atmosphere.

An individual’s perception of risk is influenced by experience as well as personal, religious and cultural contexts. Furthermore, events that are familiar, involve a natural process, seem to be under an individual’s control, are of a voluntary nature or involve a decision to forgo something are generally perceived as less risky than those that are unfamiliar, involve a man-made process, involve loss of control, are mandatory or involve a decision to do something rather than avoid something.

A decision to become immunized or immunize a child clearly falls into the latter “high risk” category regardless of the true odds. Framing the risks in the right context is very important. Countering an individual’s concerns by citing the greater dangers of a familiar event, like driving a car, while true, may be counterproductive.

For effective risk communication, physicians and other health care providers should attempt to do the following:

Communicate current knowledge.
Respect differences of opinion about immunization.
Represent the risks and benefits of vaccines fairly and openly.
Adopt a patient-centred approach.
Make the most of each opportunity to present clear, evidence-based messages regarding vaccines and immunizations. (Source: Canadian Immunization Guide, 2006)

Communication Tool

The British Columbia Communicable Disease Control program has developed a communication tool for immunization providers. It provides a step-by-step process which helps bridge the gap between clinical evidence and client knowledge. It can be accessed at the following link: BC Immunization Communication Tool

Informed Consent

Informed consent is an essential pre-condition to providing immunization. It is the professional and legal responsibility of the provider to obtain informed consent prior to immunization.

General Information about Consent

There are four basic requirements of a valid consent

It must be voluntary
It must be given by a person with the capacity to consent
It must refer to both the treatment and the provider of the treatment
It must be informed

What is informed consent for immunization?

Informed consent means the client must be provided with the information necessary to make a decision to have or to refuse treatment.

This information must include

the nature and purpose of the immunization
what the immunization is and how it will be done
the expected benefits of the immunization
the risks and possible side effects of the immunization
alternative courses of action – other things that the client can do to prevent the disease
the risks of not having the immunization

The client must also have had the chance to ask for, and receive, further information or clarification about the proposed immunization. (Source: Canadian Immunization Guide, 2006)

Clinical Practice Guidelines

Resources

Other Resources for Learning

“A Parent’s Guide to Health Information on the Internet” Canadian Pediatrics Society, Caring for Kids
Communicating Effectively About Immunization – Canadian Immunization Guide
Immunization Facts – Canadian Immunization Guide
Comparison of Effects of Diseases and Vaccines
Vaccine Safety – Frequently Asked Questions – Public Health Agency of Canada
Vaccines and autism: A tale of shifting hypothesesGerber, J.S. & Offit, P.A. (2009).. Clinical Infectious Diseases, 48, February 15, pages 456 – 461.
Your child’s best shot (2006) by R. Gold. Canadian Pediatric Society, Ottawa. This book may be available at your local library or Public Health office. It can also be ordered from the Canadian Pediatric Society Bookstore

Immunization communication tool for immunizers.- British Columbia Centre for Disease Control (2008).
“What would happen if we stopped vaccinations?” – CDC (Centers for Disease Control and Prevention, USA) website and information:
Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalance and links with immunizationsFombonne, E et al (2006).. Pediatrics. Vol 118, pages e139 – e150.
MMR vaccine does not cause autism: Examine the evidence– Immunize Action Coalition (2007).. Reviewed by U.S. Centers of Disease Control and Prevention, August 2007. Retrieved July 2009.
Addressing parents’ concerns: do vaccines contain harmful preservatives, adjuvants, additives, or residuals? Offit, P.A., & Jew, R.K. (2003). Pediatrics, Vol 112, No.6., pages 1394 – 1401.
Addressing Parents’ concerns: do Multiple vaccines overwhelm or weaken the infant’s immune system? Offit, P.A. Quarles et al (2002). Paediatrics. Vol 109, pages 124 – 129).
Canadian Immunization Guide Evergreen Edition

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