Using shared decision making in provider-parent discussions

Among all states, Washington state has one of the highest percentages of parents who opt-out of vaccines required for children to enter kindergarten. Many of these parents ask their child’s doctor to delay some or all vaccinations for their child. These ‘vaccine-hesitant’ parents are reluctant for many reasons. Pediatrician and Bioethics faculty member Dr. Doug Opel, along with staff member Katherine Lepere, is focusing on how best to communicate with vaccine-hesitant parents in order to promote ongoing discussions and ultimately to increase vaccination rates in children. Focusing on vaccine-hesitant parents is important because this is a growing group, yet their minds are not made up one way or the other yet.

By videotaping conversations between doctors and parents during well-child visits when vaccinations normally are given, Opel and colleagues hope to pinpoint trends in how doctors communicate. Specifically, they are looking at how doctors start the conversation and at the doctors’ responses if parents verbally resist the recommended vaccines. In an initial study, they found that if doctors took a presumptive approach to initiating the vaccine discussion ( “So today we’re doing X and Y vaccines”) rather than a participatory one ( “What do you want to do about shots today?”), parents were more likely to accept the recommended vaccines due at that visit but reported a lower visit satisfaction experience. The opposite was true if doctors used a participatory approach to initiating the vaccine discussion – parents reported higher satisfaction with the office visit, but were less likely to accept all recommended vaccines during that visit.

“Finding that doctors began their vaccine discussions with parents with divergent approaches – presumptive or participatory – and had equally divergent outcomes not only raises some interesting questions regarding vaccine practice and policy, but also suggests we are only at the beginning of our understanding of what constitutes effective communication with parents about vaccines.”

Dr. Doug Opel

The outbreak of measles at Disneyland and other recent outbreaks of diseases that are preventable with vaccines have garnered Opel’s research much media attention. Major newspapers have interviewed him and featured his research. He was mentioned in a February 4, 2015, New Yorker article as one of a handful of academics who are going “excellent work” on this topic. The Wall Street Journal ran Vaccines: Delays, Too, Pose Risks on February 9, 2015.

Ultimate Goal

To improve childhood immunization rates by teaching providers how best to communicate with vaccine-hesitant parents.


  • Rita Mangione-Smith, Seattle Children’s
  • James Taylor, University of Washington
  • John Heritage, UCLA
  • Jeff Robinson, Portland State
  • Sheryl Catz, Group Health
  • Nora Henrikson, Group Health