robert m jacobson, md, faap professor of pediatrics, mayo clinic president, semic med dir, mayo’s...
TRANSCRIPT
![Page 1: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/1.jpg)
Robert M Jacobson, MD, FAAPProfessor of Pediatrics, Mayo Clinic
President, SEMICMed Dir, Mayo’s Primary Care Immun ProgramPresident, MN Chap Amer Acad of Pediatrics
Working with Vaccine Hesitant Parents using the
C.A.S.E. Approach
![Page 2: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/2.jpg)
Disclosures
• Potential conflicts– Safety Review Committee • Male HPV4 Gardasil® vaccine (Merck)
– Data and Safety Monitoring Board• Adult and infant PCV15 (Merck)
• No off-label use discussion
![Page 3: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/3.jpg)
Disclosures
• Potential conflicts– Jacobson v Massachusetts– Reverend Henning Jacobson– Martin Bror Johan Jacobson– Robert Bror Jacobson
![Page 4: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/4.jpg)
Learning Objectives
• Relate a new approach to vaccine hesitancy• Identify each of its 4 components• Describe how it works in 3 common scenarios
![Page 5: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/5.jpg)
The State of Vaccination
• The anti-vaccine movement is thriving– Successful vaccination makes its value invisible– Media seeks to portray controversy, “both sides”– Americans culturally opposed to “social health”
• Vaccine hesitancy is a major issue– Not just among exempters and delayers– Even 25 to 30% of those up-to-date
• Both vaccine provider and parent struggle
![Page 6: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/6.jpg)
The Vaccine Provider in the Office
• Has little time for discussion• Suffers a sense of rejection as wise advisor• Feels sense of futility• Recognizes problem of health illiteracy
![Page 7: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/7.jpg)
The Parent in the Office
• Would like to be heard• Wishes to be respected• Seeks credible information• Wants control; wants to make the decision
![Page 8: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/8.jpg)
The Back Fire Effect
• Nyhan et al 2014• 1759 parents 18 years and older• Two waves of online messaging• Randomized 5 different interventions– Info explaining the lack of evidence re autism– Info re dangers of diseases prevented by MMR – Images of children w/diseases prevented by MMR– Dramatic narrative re infant almost died of measles– Control group
![Page 9: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/9.jpg)
The Back Fire Effect
• Results– None of 4 interventions increased intent to
vaccinate– Info re autism improved expressed knowledge but
decreased intent to vaccinate– Images and narrative worsened fears re autism
![Page 10: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/10.jpg)
Clinician Recommendation Matters
• Many studies across many vaccines and ages– Gnanasekaran 2006– Nowalk 2007– Guerry et al 2011– Brewer et al 2011– Ylitalo et al 2013– Darden et al 2013– Jacobson and Darden 2014
• Clinician recommendations increase rates
![Page 11: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/11.jpg)
Hey, lady! Where do you want this
health care delivered?
![Page 12: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/12.jpg)
Information Transfer Not Enough
Hey, lady! Where do you want this
health care delivered?
![Page 13: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/13.jpg)
![Page 14: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/14.jpg)
Rhetoric
![Page 15: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/15.jpg)
Rhetoric
Logos
![Page 16: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/16.jpg)
Rhetoric
Logos
Ethos
![Page 17: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/17.jpg)
Rhetoric
Logos
Pathos Ethos
![Page 18: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/18.jpg)
Persuasion
Information
Passion Standing
![Page 19: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/19.jpg)
![Page 20: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/20.jpg)
The C.A.S.E. for Vaccines
• A model for talking to vaccine-hesitant parents • A mnemonic to organize a rapid, useful response• Created by Alison Tepper Singer– Formerly, NBC and CNBC television producer – Mother of an autistic child– Quit Autism Speaks over its anti-vaccination stance– Founding CEO of Autism Science Foundation– Strong advocate of science and routine vaccination
![Page 21: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/21.jpg)
The Case for C.A.S.E.
• Provides more than just information• Has historical roots in Aristotelian rhetoric• Lacks published studies of its efficacy• Nonetheless has face validity• Lacks competing alternatives• Preserves the relationship
![Page 22: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/22.jpg)
The C.A.S.E. Acronym
• Corroborate• About Me• Science• Explain/Advise
![Page 23: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/23.jpg)
The C.A.S.E. Approach
• Corroborate:– Acknowledge the person’ concern – Find some point on which you can agree– Set the tone for a respectful, successful talk
• About Me:– Describe what you have done to build your knowledge base and
expertise
• Science: – Relate what the science says
• Explain/Advise: – Explain your advice to patient, based on the science
![Page 24: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/24.jpg)
A Hesitant Parent
We want to pass on the MMR vaccine
today. The others are fine.
![Page 25: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/25.jpg)
C for Corroborate
Please tell me why you want to pass on the MMR vaccine.
![Page 26: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/26.jpg)
The Parent’s Specific Concern
I’m worried that it might cause autism.
There’s just too much in the news about it.
![Page 27: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/27.jpg)
More Corroboration
If the MMR vaccine caused autism, I wouldn’t want your child to get it
either. Just like you, I want to do whatever I can
do to keep your child healthy.
![Page 28: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/28.jpg)
A for About Me
I have been studying this claim for many years now and have read the studies that tested whether the MMR vaccine
causes autism. I’ve also been reading the studies about the
autism itself.
![Page 29: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/29.jpg)
S for Science
Dozens of very large, well-done studies have shown that
the MMR vaccine does not cause autism.
![Page 30: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/30.jpg)
More Science
In fact, the studies about autism show that children who are going to get autism show
the signs of autism long before they receive the MMR vaccine.
![Page 31: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/31.jpg)
More Science
On the other hand, the MMR vaccine prevents measles
disease, and I have seen how serious measles disease can be. 1 in 3 children have been
so sick they had to be hospitalized. Some die of
measles.
![Page 32: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/32.jpg)
E for Explain
We both want your child healthy. Your passing on the MMR will not protect your child from autism,
but it will leave your child at risk for diseases that can result in
hospitalization or worse. As your child’s doctor, I urge you to have your child get the MMR vaccine.
![Page 33: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/33.jpg)
Another Hesitant Parent
It’s just too many shots at once. I just want to spread them out and give them
one at a time.
![Page 34: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/34.jpg)
C for Corroborate
We do give more injections now in the first few visits. What specifically worries
you about that?
![Page 35: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/35.jpg)
More Specifics
Won’t it overload her immune system? How do we know it’s really
safe?
![Page 36: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/36.jpg)
More Corroboration
You are not the first parent to ask that question. My own
spouse asked me about that at our first baby’s two-month
check-up.
![Page 37: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/37.jpg)
A for About Me
So I read through the recommendations carefully and the discussions among experts about the safety of
giving all these vaccines together.
![Page 38: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/38.jpg)
S for Science
Although kids get more shots today, they actually receive fewer
antigens than when they got fewer shots, because technology has enabled us to make vaccines that have only the part of the cell that induces immune response.
![Page 39: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/39.jpg)
More on Science
Plus, the immunological challenge from a vaccine is
nothing compared to what kids fight off every day. An ear
infection is a bigger immunological challenge.
![Page 40: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/40.jpg)
E for Explain/Advise
We want all the kids in our practice to be immunized so that they have the greatest
chance for a long, healthy life. I made sure my own children
got all the vaccines recommended on time.
![Page 41: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/41.jpg)
A Hesitant Mother-to-Be
I don’t want a Tdap, I just had one after I had my baby two years ago. It just
doesn’t seem safe.
![Page 42: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/42.jpg)
C for Corroborate
I too wondered about the frequency
of getting Tdap during every
pregnancy. We used to say only one Tdap
ever.
![Page 43: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/43.jpg)
A For About Me
So, I went to the recommendations that were
just published to better understand the reasoning and
the data a Tdap for each pregnancy.
![Page 44: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/44.jpg)
S For Science
Pertussis can be most severe in infant who have started
their vaccination. The majority of deaths occur in infants less
than three months old.
![Page 45: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/45.jpg)
More on Science
I learned that the recommendation was made to take advantage of the mother’s
ability to pass on pertussis protection to the baby so the
baby is protected until they are old enough to get vaccinated.
![Page 46: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/46.jpg)
More on Science
Because the level of protective antibodies declines after the first year of vaccination, it won’t protect babies from
future pregnancies.
![Page 47: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/47.jpg)
More on Science
Meanwhile studies show the Tdap is safe to pregnant
mothers and their fetuses. That’s why they’ve made this
recommendation.
![Page 48: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/48.jpg)
More on Science
So far what experts have observed is swelling and
redness at the injection site. It won’t cause you harm and it
just may save your baby’s life.
![Page 49: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/49.jpg)
E for Explain/Advise
Protecting your baby against pertussis in the first couple
months is so important that I recommend that you get the
Tdap today.
![Page 50: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/50.jpg)
Other Forms of Corroborate
• I’ve heard that too• I first thought that as well• Lots of parents wonder about that• We both want your child healthy, safe, and
free of disease
![Page 51: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/51.jpg)
Other Forms of About Me
• This is one of the most important things I do• I’ve been studying this topic for years• I’ve dedicated my life to this work• I lose money on vaccines but I don’t regret it
![Page 52: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/52.jpg)
Other Forms of Science
• Let me tell you a story about a patient of mine…• No vaccine is 100% safe but studies show…• I asked a leading expert the same question…
![Page 53: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/53.jpg)
Other Forms of Explain/Advise
• That’s why I got the vaccine myself• That’s why I made sure my baby got this vaccine• If I had children, I’d get them this vaccine• If I were in your shoes, I’d choose to vaccinate• I feel more strongly about this than I do about
antibiotics for ear infections
![Page 54: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/54.jpg)
C.A.S.E.
• Not just information• Not scare tactics• But your advice
• You have more than the science• You have your connection with the parent• You have your standing with the parent• You have the passion you hold for your advice
![Page 55: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/55.jpg)
The C.A.S.E. Approach
• Corroborate:– Connect emotionally with the parent
– About Me:– Buttress your professional standing with the parent
• Science: – Summarize the science
• Explain/Advise: – Passionately advise given your status or standing and the
science
![Page 56: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/56.jpg)
Practice
• Pair up in twos• Have one play the role of a hesitating parent • Have one play the role of vaccine provider• Work through all four steps of C.A.S.E.– Corroborate– About Me– Science– Explain/Advise
![Page 57: Robert M Jacobson, MD, FAAP Professor of Pediatrics, Mayo Clinic President, SEMIC Med Dir, Mayo’s Primary Care Immun Program President, MN Chap Amer Acad](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649dab5503460f94a9a8e5/html5/thumbnails/57.jpg)
Summary
• Relate a new approach to vaccine hesitancy– Passionately advise using science and standing
• Identify each of the 4 components of C.A.S.E.– Corroborate – About Me– Science– Explain/Advise
• Describe how it works in 3 common scenarios