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SCDM for RSV Vaccines
Our Role as Physicians: Discussing RSV Vaccination With Our Patients

Released: March 12, 2024

Jewel Mullen
Jewel Mullen, MD, MPH, MPA, FACP
Activity Information

Activity

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Key Takeaways
  • Older adults are at risk for severe RSV disease, especially those with comorbidities 
  • RSV vaccines for older adults are safe and effective 
  • RSV vaccination should be offered to all adults aged 60 years and older using shared clinical decision-making 

    At a recent webinar, I asked an audience of advanced practice practitioners, family medicine doctors, pediatric specialists, and internists what they thought about having a discussion with their older adult patients about respiratory syncytial virus (RSV) vaccines. 

    The audience spanned many generations—some were early in their practice or finishing their residencies, others were more established, and some retired. But their answers about shared clinical decision-making (SCDM) for RSV vaccines were consistent:

    “Sounds nice, but who has time for long conversations?”

    “Sounds nice, but we don’t know enough about the risks and benefits to be able to guide our patients well.”

    “Sounds nice, but isn’t it more helpful to give specific recommendations? Shouldn’t we tell them to just get it?”

    I walked away from those interactions thinking that we, as healthcare professionals (HCPs), need to be more proactive and confident about involving our patients in SCDM. We often base our advice about vaccines on a population-level understanding of their benefits and risks. When it comes to the RSV vaccine, we need to be informed about the burden of disease and benefits of the vaccine based on patient risk to become comfortable having effective conversations with our patients as they decide whether to receive it.

    In fact, this is one of the challenges that my colleague, Angela Branche, MD, FIDSA, and I will address in our live symposium at ACP 2024 in Boston, Massachusetts, which you can register for here.

    Our Role as Physicians
    I believe that, in choosing medicine as a profession, HCPs must embrace the role of the doctor as teacher. In fact, the word “doctor” comes from the Latin word “docere,” meaning “to teach.”

    I want to believe that I have exemplified the role of “teacher” for my patients by providing medical information to help them make their own choices. Sharing information and assessing the pros and cons with them helps center their preferences in our conversations. That is quite different from the paternalistic approach that HCPs have been abandoning for decades, and instead, HCPs are adopting SCDM to support patient autonomy. At the end of the day, we are here to help patients make decisions for their health, not just tell them what to do.

    Communication Is Key
    Returning to the example of the doctors I spoke with during the webinar that promoted advocacy for primary care, at the heart of the matter, many of them have been longing to better communicate with their patients.

    It is possible that some HCPs are hesitant to use SCDM for situations such as discussing the RSV vaccine because they lack confidence in knowing enough about the vaccine and fostering a patient’s ability to not make the “wrong” decision. I do not think these concerns come from a risk management perspective or out of fear of litigation. What HCP wants to be inaccurate when communicating health information? In circumstances where our patients are reluctant to choose a treatment, we may feel even less confident inviting them to SCDM if we worry we will anger or alienate them.

    In the absence of a formal public health recommendation, what does SCDM about RSV vaccination mean in the day-to-day context of a busy practice? Why should primary care physicians take the time to address this if some patients will go to a pharmacy to get their vaccine or if some patients cannot afford the vaccine in the first place?

    Even with all these circumstances, it is up to us to find opportunities to educate our patients. Many who are at risk for severe disease may miss out on protection if we do not inform them of how the vaccine can protect them. We can help them consider their individual risk and benefits alongside their goals for their own health and well-being by employing SCDM whenever we can. Information is important to our patients, and when it comes to something like the RSV vaccine in older adults, many of our patients are not aware of their own risk.

    Assessing Risk
    How can we help patients understand their own risk? I can use the discussion I had with myself as an example. I am older than 60 years of age. Fortunately, I am healthy with the exception of mild asthma that is most often triggered by seasonal allergies or a bad respiratory infection.

    My age alone makes me a good candidate for a discussion about the RSV vaccine. In general, older adults are at risk for severe RSV disease, but in assessing my own risk, my asthma is mild enough that I might have said to myself, “You know, you’re probably not really at risk for severe disease. Maybe you don’t need the vaccine.”

    What moved me to get vaccinated was my hope to avoid weeks of RSV/asthma-induced inconvenience. People with chronic lung, cardiovascular, renal, or liver disease or other serious chronic conditions, such as immunocompromised conditions and diabetes mellitus, bear a greater risk of severe RSV disease and complications (eg, hospitalization, mortality).

    I also thought about my family. I thought about my pregnant daughter-in-law and my soon-to-be-born grandchild. I thought about my husband and other family members who are close to my age who, even after they talk to their doctor, are going to ask me what I think they should do.

    So in my decision-making, I chose to get the vaccine for my family members as well as for myself.

    I think that going through this type of decision-making process for myself is key to being able to empathize with my patients and successfully use SCDM. This experience illustrates that getting comfortable with conversations about risk and benefit is both a medical and personal issue because as HCPs we all have more than one identity.

    More Than One Approach
    Understanding the different approaches for SCDM will be useful to see what works for you and the patients you see. For example, sometimes the best approach might be more than just explaining the risk of being unvaccinated—the best approach might be helping patients understand both the risk and the evidence for the vaccine. It is important that they know that RSV vaccines are safe and effective. In addition, if you are not confident in having these conversations with your patients, I encourage you to learn more about the vaccine and approaches to SCDM.

    The American College of Physicians once launched a Doctors for Adults campaign, and as our society ages, I think we are increasingly becoming doctors for older adults. That means we are becoming doctors for a larger share of the population with chronic comorbidities—who are therefore ideal candidates for the RSV vaccine.

    At the end of the day, whether patients choose to get vaccinated might not depend on how they come to the conversation, but rather on how we as HCPs come to the conversation.

    Learn More

    For the RSV vaccine, I think there are 3 main points HCPs need to understand:

    1. Older adults are at risk for severe RSV disease, especially those with comorbidities
    2. RSV vaccines for older adults are safe and effective
    3. RSV vaccination should be offered to all adults aged 60 years and older using SCDM

    To learn more about how we can be clear in counseling our patients about what the RSV vaccine will and will not do for them, join me and Dr Branche at our live symposium at ACP 2024 in Boston, Massachusetts. You can participate in person or via live simulcast. 

    How do you incorporate SCDM when discussing the RSV vaccine with your older adult patients? Join the discussion by posting a comment.