Talking with adult patients who have questions

Information

Resource type: Conversation guide

Resource Format: PDF

SKAI Topic: Adult

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About this resource

This resource aims to support your conversations with adult patients who have questions and concerns about vaccinations, including COVID-19 vaccination.

This page and the downloadable PDF provide detailed guidance including phrases to use and the evidence behind the steps.

We have also produced a quick guide as a short visual summary of the recommended steps.

To have a supportive vaccination conversation with a hesitant adult patient, the SKAI approach¹ recommends the following six steps:

Elicit
Acknowledge
Set agenda
Share knowledge
Recommend vaccination
Close

Studies have shown that a patient is more likely to vaccinate if they get a strong recommendation from a healthcare professional.^2,3

But conversations about vaccination aren't always easy. In our research⁴, healthcare professionals told us they wanted some specific guidance on how to have constructive conversations about vaccination with their patients.

This resource demonstrates how the SKAI communication approach can be applied to conversations with adults who have questions and concerns about vaccination. The SKAI approach is based on motivational interviewing.¹ This resource adapts and expands on the original SKAI package which was designed to support conversations with parents about childhood vaccination.

The development of this resource was informed by a review of the literature, and consultation with healthcare professionals and social scientists. The evidence we gathered suggested that the steps in the new resource should be based on the original SKAI communication approach, developed by social scientist and vaccine communication expert Professor Julie Leask from the University of Sydney and a team of other researchers.

In this new resource, some words and phrases have been adapted to suit an adult audience, talking about vaccination for adults.

As a healthcare professional, preparing for conversations with patients from diverse communities means tailoring your approach. Implement the strategies below to help ensure all your patients receive the necessary information to make informed decisions about vaccination.

Patients from culturally and linguistically diverse (CALD) communities.
Patients from culturally and linguistically diverse (CALD) backgrounds can face unique challenges when encountering health services. Cultural differences and practices as well as language barriers can impact communication and healthcare decision-making. Respecting cultural beliefs and customs builds trust and rapport with your patients and ensures they feel heard and understood. You can use the following resources when interacting with patients from CALD backgrounds:

Language services. Professional interpreters facilitate clear communication between healthcare providers and patients. Translating and Interpreting services (TIS National) may be of assistance.
Multilingual written materials. Some useful resources about COVID-19 vaccination available in various languages and developed for CALD communities include:
- The COVID-19 glossary (specific health and vaccination terms in 29 languages)
- The COVID-19 vaccination decision aid (available in Greek, Vietnamese, Arabic, Simplified Chinese, Traditional Chinese)
- CALD resources about COVID-19 (links to CALD resources about COVID-19 and the National Vaccination Program)
- Coronavirus: Updates, Resources & News for CALD Communities (translated resources for CALD communities)

Patients with disabilities and elderly people living in aged care.
Patients with disabilities and elderly people living in aged care may rely on caregivers, family members or legal guardians for help with decision-making. It is vital that you ensure you have informed consent for vaccination. If you are obtaining consent from a substitute decision-maker, you should refer to the relevant state and territory laws. Additionally, the following approaches may be useful when you are interacting with patients with disabilities or elderly people living in aged care:

Direct communication. As a healthcare professional, you should actively involve your patient in decision-making. Use clear language, easy-read documents or visual aids where relevant. Involve the patient’s designated caregivers, family members or legal guardians who support their decision-making.
Document the informed consent process. Whether you obtain written consent (preferred) or verbal consent from your patient, you should document the process in your clinical notes. Include details around how the patient participated, and any accommodations made. More information on informed consent for people with disabilities can be found here.

For further information on additional support you can provide and practice adjustments you can make when vaccinating individuals with additional needs, please access this guidance.

This resource is part of the SKAI package to support vaccine conversations between healthcare professionals and their patients. You can find more resources to support vaccine communication in the healthcare professionals section of the SKAI website.

If you would like to provide feedback on this resource, please get in touch by phone, mail or email.

Randall S, Leask J, Robinson P, et al. Underpinning of the sharing knowledge about immunisation (SKAI) communication approach: a qualitative study using recorded observations. Patient Education and Counseling 2020;103(6):1118–24.
Opel DJ, Mangione-Smith R, Robinson JD, et al. The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health 2015;105(10):1998–2004.
Leask J, Kinnersley P, Jackson C, et al. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatrics 2012;12(1):154. doi: 10.1186/1471-2431-12-154
Abdi I, Bolsewicz K, Bullivant B, Marques M, Steffens M. Understanding the factors that influence communication about COVID-19 vaccines with patients: perspectives of Australian immunisation providers. Vaccine X 2023 Aug;14:100304. doi: 10.1016/j.jvacx.2023.100304

The immunisation encounter

You have just discussed with your patient that they are due for their COVID-19 vaccination, and they have some questions and concerns (they are ‘hesitant’). What should you do?

Here are the recommended SKAI steps to help you to have a supportive vaccination conversation.

Step 1. Elicit

Elicit your patient’s questions and concerns about immunisation. This involves asking open-ended questions, such as:

“Do you have some questions?”

Use active listening, which means giving the patient your undivided attention; using verbal and non-verbal (e.g. making eye contact, nodding your head ) cues to show that you’re listening; and providing feedback to ensure you understand the patient’s message correctly.¹

Step 2. Acknowledge

Acknowledge your patient’s concerns and validate your patient. This does not necessarily mean that you agree with your patient’s concerns. Instead, it shows that you are listening. In this process, your patient feels heard. You could validate your patient with a response such as:

“Thank you for sharing. It sounds like you’re worried that…”

Try to use a non-judgemental approach. Be empathetic and thank the patient for sharing their concerns. Acknowledge uncertainty (where it exists) to build trust.

Step 3. Set the agenda

Set the agenda for addressing concerns. Summarise your patient’s questions and concerns by working them into a list. You may not be able to answer everything during this consultation, so prioritise key questions. For example:

“Let’s compile all your concerns into a list, and we’ll prioritise two of your most pressing concerns to address today, and work through them one by one – will that be okay?”

Step 4. Share knowledge

Share knowledge about immunisation. Tell your patient you have some information that may be helpful in addressing their questions and concerns and ask them if they would like to see it, for example:

“I have some information here that goes into detail about some of your concerns. Would you like me to share it with you?”

Keep information short and to the point, and tailor the information to the concerns the patient has just shared with you (in other words, do not provide generic information).

Explore your patient’s motivations to vaccinate. This involves looking for signs that your patient may have some motivation to vaccinate (for example, concerns about the disease that can be prevented with the vaccine) and reinforcing that motivation. For example, you could say:

“Thank you for sharing your concerns about COVID-19. I agree with you, it can be serious. Getting a COVID-19 vaccine can provide protection.”

Step 5. Recommend vaccination

Make a recommendation to your patient to get vaccinated. Studies have shown that your strong recommendation to vaccinate can really make a difference in whether your patient vaccinates or not.^2,3 You could say:

“I recommend that you have the COVID-19 vaccine today. It will help protect you and your family.”

Frame messages in terms of how the vaccine may benefit your patient and their family.^4,5 Respect the patient’s autonomy but be clear in your recommendation. Positively reinforce their decision to get vaccinated.

Step 6. Close

Close the consultation but keep the conversation going. At this stage, it is important to re-check intentions and confirm that your patient wants to get the vaccination:

“Are you happy to get a COVID-19 vaccine today?”

If your patient is not ready to receive the vaccination, keep lines of communication open and offer to book the appointment on another day or time:

“Let’s book another appointment to discuss this again.”

If you are not able to answer all your patient’s queries and concerns due to limited consultation time, offer to schedule another appointment. If you are not able to answer complex queries, offer to refer your patients to a specialist or other healthcare professional who can. Acknowledging that you may not be able to answer all questions and concerns may enhance your patient’s trust and confidence in your advice.⁶ Thank your patient for sharing their vaccination concerns with you.

References

Miller E, Webb L. Active listening and attending: communication skills and the healthcare environment. In: Webb L (editor). Nursing: communication skills for practice. Oxford: Oxford University Press; 2011. pp 52‒71.
Opel DJ, Mangione-Smith R, Robinson JD, et al. The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health 2015;105(10):1998‒2004.
Leask J, Kinnersley P, Jackson C, et al, Communicating with parents about vaccination: a framework for health professionals. BMC Pediatrics 2012;12(1):154. doi: 10.1186/1471-2431-12-154
Finney Rutten LJ, Zhu X, Ridgeway JL, et al. Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy. Mayo Clin Proc 2021;96(3):699‒707.
Chou W-YS, Budenz A. Considering emotion in COVID-19 vaccine communication: addressing vaccine hesitancy and fostering vaccine confidence. Health Communication 2020;35(14):1718‒22.
Berry NJ, Danchin M, Trevana L, et al. Sharing knowledge about immunisation (SKAI): an exploration of parents’ communication needs to inform development of a clinical communication support intervention. Vaccine 2018;36(44):6480‒90.