Jennifer R. Hartmark-Hill, MD, FAAFP, Associate Professor at University of Arizona, College of Medicine - Phoenix
Digital - March 2022
“Patients yearn for compassion and kindness, faith and hope.”
– Howard M. Spiro, MD (1)
In the Spring 2022 issue of Arizona Physician magazine, the challenges of vaccine hesitancy are considered, from historical perspectives to modern day community practices and public health department advocacy. Providing support for patients to navigate complex decision-making and to access credible resources in an informed manner is key, yet this endeavor remains exceptionally challenging in many cases.
This article seeks to complement reflections on challenges and solutions with further exploration of evidence-based approaches to nurture compassion and humanism in medicine. These approaches are of benefit both to patients and health professionals, and are characterized by the integration of scientific knowledge with compassion-informed communication and care. (2,3) In alignment with quadruple aim, this resource encourages future skill-building to promote improved patient experiences and population health, as well as considerations consistent with more satisfying and sustainable practice for clinicians who may be currently experiencing burnout and moral distress in the face of trying times. (4)
What is currently known is that:1) compassionate, person-centered approaches to care have been shown to improve patient outcomes. Better communication and trust result in more informed-decision-making, enhancement of motivation, and 2) the need for such approaches is ever-increasing in our increasingly complex, technologically advancing systems. (5,6)
Despite the many challenges of practicing medicine, compassion for challenging patient circumstances, relationship building communications, and collaborative care planning which takes into account patient values has been also shown to improve meaning-making and satisfaction for those engaged in patient care. (3)
Selected recommendations and references to support compassionate approaches to current challenges are outlined in Table 1. A supplementary resource for practical patient communication approaches is available here.
1) Take a person-centered approach to patient care. (7,8)
Acknowledge concerns with empathy and respect. (3,9)
Affirm patient values. (10)
Build trust through knowledge, confidence and relational communication strategies at the individual and systems levels. (9,11)
Consider approaches that foster change, such as “Motivational Interviewing.” (12)
Develop approaches and tools to promote shared decision-making. (14)
Employ the “teach back” method to confirm effective information-sharing or adapt to patient needs. (15)
2) Take institutional and systemic leadership approaches to supporting health care professionals. (10,15)
Extend needed support and resources. (16)
Engage in decision-making consistent with the quadruple aim. (4)
Prior to the emergence of the COVID-19 pandemic, the World Health Organization had identified vaccine hesitancy as a top ten threat to global health. In recognition of the potential impact of persistent vaccine hesitancy population health, evidence-based approaches to prepare trainees and physicians to expertly address vaccine hesitancy should integrated as core components of medical education, and should be implemented developmentally across the undergraduate, graduate and continuing medical education continuum. (10,17,18)
Curricular training tools that can be applied or adapted to foster compassionate and competent support for patients who are experiencing vaccine hesitancy include the following examples:
Coleman, Allison, and Deborah Lehman. "A flipped classroom and case-based curriculum to prepare medical students for vaccine-related conversations with parents." MedEdPORTAL 13 (2017).
Morhardt, Tina, et al. "Vaccine curriculum to engage vaccine-hesitant families: didactics and communication techniques with simulated patient encounter." MedEdPORTAL 12 (2016).
Trainees & Practicing Physicians
Blake H, Fecowycz A, Starbuck H, Jones W. COVID-19 Vaccine Education (CoVE) for Health and Care Workers to Facilitate Global Promotion of the COVID-19 Vaccines. International Journal of Environmental Research and Public Health. 2022; 19(2):653.
1. Kravetz R. Medical humanism: Aphorisms from the bedside teachings and writings of Howard M, Spiro, MD. Yale University School of Medicine. New Haven, CT ©2008
2. Trzeciak S, Roberts B, Mazzarelli A. "Compassionomics: hypothesis and experimental approach." Medical hypotheses. 2017; 107: 92-97.
3. Trzeciak S, Mazzarelli A, Booker C. Compassionomics: The revolutionary scientific evidence that caring makes a difference. Pensacola, FL: Studer Group, 2019.
4. Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine. 2014;12:573-576.
5. Kerasidou A. Artificial intelligence and the ongoing need for empathy, compassion and trust in healthcare.Bulletin of the World Health Organization. 2020; 98:(4) 245.
6. Szilagyi P, Thomas K, Shah M, et al. The role of trust in the likelihood of receiving a COVID-19 vaccine: Results from a national survey. Prev Med. 2021;153:106727.
7. Eklund J, Holmström I, Kumlin T, Kaminsky E, Skoglund K, Höglander J, Sundler A, Condén E, Meranius M. Same same or different? A review of reviews of person-centered and patient-centered care. Patient Education and Counseling. 2019;102(1):3-11.
8. Laine C, Davidoff F. Patient-centered medicine: a professional evolution. JAMA. 1996;275(2):152-6.
9. Boissy A, Gilligan T. Communication the Cleveland Clinic Way: How to Drive a Relationship-Centered Strategy for Superior Patient Experience. McGraw Hill; 2018.
10. Rutten L. Finney, et al. Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy. Mayo Clinic Proceedings. 2021; 96:3
11. Charon R. The patient–physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286(15):1897–902.
12. Gagneur A. Respiratory syncytial virus: Motivational interviewing: A powerful tool to address vaccine hesitancy. Canada Communicable Disease Report. 2020;46(4):93.
13. Gabarda A, Butterworth SW. Using Best Practices to Address COVID-19 Vaccine Hesitancy: The Case for the Motivational Interviewing Approach. Health Promotion Practice. 2021; 15248399211016463.
14. Elwyn G, Cochran N, Pignone M. Shared Decision Making—The Importance of Diagnosing Preferences. JAMA Intern Med. 2017;177(9):1239–1240.
15. Coleman C, Hudson S, Pederson B. Prioritized health literacy and clear communication practices for health care professionals. HLRP: Health Literacy Research and Practice. 2017 Jul 1;1(3):e91-9.
16. Reitz K, Terhorst L, Smith C, Campwala I, Owoc M, Downs-Canner S, Diego E, Switzer G, Rosengart M, Myers S. Healthcare providers’ perceived support from their organization is associated with lower burnout and anxiety amid the COVID-19 pandemic. PloS one. 2021; 16(11):e0259858.
17. World Health Organization. Ten threats to global health in 2019. Available from: https://www.who.int/news-room/spotlight/ten-threatsto-global-health-in-2019. Accessed January 15, 2022
18. Blake H, Fecowycz A, Starbuck H, Jones W. COVID-19 Vaccine Education (CoVE) for Health and Care Workers to Facilitate Global Promotion of the COVID-19 Vaccines. International Journal of Environmental Research and Public Health. 2022; 19(2):653.
19. Adawi Awdish, Rana Lee. "You Don't Ever Let Go of the Thread." Annals of internal medicine. 2021;174(11): 1628-1629.