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Effectiveness of CONFIVAC, an intervention to enhance paediatric nurses and paediatricians skills to promote vaccination: A mixed-methods cluster randomized trial
Vaccine hesitancy (VH) poses a significant challenge to achieving optimal vaccination coverages worldwide. Paediatric healthcare workers (PHCWs) are fundamental in promoting vaccination but often lack adequate training to address VH. We designed CONFIVAC, a short evidence-based training program to enhance PHCWs' effective behaviours, specific knowledge and communication skills in managing VH and fostering a culture of immunization in primary care. This study evaluates its effectiveness.
Mixed methods study including a cluster-randomized trial with 142 PHCWs in Barcelona and Central Catalonia, Spain, from October 2023 to February 2024 and a qualitative study. Paediatric teams were randomized into intervention (CONFIVAC) and control (standard care) arms. CONFIVAC included 12 h of online and in-person training on vaccine knowledge, communication strategies, and organizational tools. Participants answered self-administered questionnaires at baseline (T0) and four months later (T1). Key outcomes were vaccine-promoting behaviours (presumptive communication, anticipation of upcoming vaccines, and explicit vaccine recommendations) and self-perception of adequate training to handle VH. We performed logistic regression models to estimate odds ratios (OR) with 95 % confidence intervals using an intention-to-treat approach. Focus groups provided qualitative insights through thematic analysis.
At T1, PHCWs in the intervention arm were more likely to use presumptive communication (aOR:4.05 [2.30;7.15]) and anticipate upcoming vaccines (aOR:2.64 [1.50;4.65]) than controls. Explicitly recommending vaccination when encountering cases of VH did not reach statistical significance (aOR:1.75 [0.89;3.44]). Self-perception of adequate training was higher in the intervention arm (aOR:3.85 [2.10;7.03]). Satisfaction with the training was high. Focus group participants reported improved communication strategies, more empathy towards VH families, and increased confidence in managing VH situations.
CONFIVAC increased PHCWs' vaccine-promoting behaviours and self-efficacy, demonstrating the value of an accessible, evidence-based training program to support vaccination efforts in routine practice.
ClinicalTrials.govNCT06489236
Journal Article
Mean streak
Dr. Emory Charbonneau, a pediatrician and marathon runner, disappears on a mountain road in North Carolina. By the time her husband Jeff, miffed over a recent argument, reports her missing, the trail has grown cold. Literally. Fog and ice encapsulate the mountainous wilderness and paralyze the search for her. While police suspect Jeff of \"instant divorce,\" Emory, suffering from an unexplained head injury, regains consciousness and finds herself the captive of a man whose violent past is so dark that he won't even tell her his name. She's determined to escape him, and willing to take any risks necessary to survive. Unexpectedly, however, the two have a dangerous encounter with people who adhere to a code of justice all their own. At the center of the dispute is a desperate young woman whom Emory can't turn her back on, even if it means breaking the law. As her husband's deception is revealed, and the FBI closes in on her captor, Emory begins to wonder if the man with no name is, in fact, her rescuer.
Book
Motivational interviewing from the paediatricians’ perspective: assessments after a 2-day training for physicians caring for adolescents with chronic medical conditions (CMCs)
Background
Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians’ attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility and implementation of MI sessions in everyday practice are missing from the physicians’ point of view.
Method
The present study was conducted as a mixed methods design. Twenty paediatricians were randomized to a 2-day MI course followed by MI consultations. Data were collected through a questionnaire one year after MI training. Factors for effective training and possible barriers to successful use of MI were examined.
Results
Completed questionnaires were returned by 19 of 20 paediatricians. The paediatricians’ experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95% of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7% percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow.
Conclusions
MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and provided a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly.
Trial registration
The study was registered in the German Clinical Trials Register (DRKS00014043) on 26/04/2018.
Journal Article
A light in the darkness : Janusz Korczak, his orphans, and the Holocaust
\"From National Book Award finalist Albert Marrin comes the ... story of Janusz Korczak, the heroic Polish Jewish doctor who devoted his life to children, perishing with them in the Holocaust\"--Provided by publisher.
Book
Comparison of wellness/burnout between primary care pediatricians and pediatric subspecialists
Background
Burnout in the field of healthcare is among the most important challenges encountered across our workforce. Provider burnout increases the risk of personal manifestations of stress, impaired job performance, and provider turnover. There is limited evidence that suggests that pediatricians are less prone to burnout than other physicians, and that pediatric subspecialists (PSPs) had been more prone to burnout than primary care pediatricians (PCPs), though there is some evidence that the relative prevalence of burnout among PCPs and PSPs changed in recent years. In response to the aforementioned factors, our large suburban pediatric multispecialty practice instituted a wellness program in 2021 with the goal of assessing the prevalence of provider burnout, and in turn developing strategies and processes aimed at improving provider wellbeing. The goal of this study was to analyze data obtained during the first three years of our wellness program, and specifically, to compare PCPs and PSPs for evidence of burnout and stress at work; and to identify triggers which contribute to burnout.
Methods
Following exemption from our local IRB, a retrospective review was performed of all anonymized data obtained from 2021 to 2024. All PCPs and PSPs were requested to complete the Maslach Burnout Inventory (MBI) and the Mini-Z 2.0 Survey, as the initial data point of a phased roll-out, as part of the organization’s provider wellness program. The goal was to use this data to inform next steps in the organization’s provider wellness plan. This data was then analyzed for differences in wellness, burnout, and drivers of burnout between PCPs and PSPs.
Results
106 PCPs and 100 PSPs completed the surveys, which represents 75% of all providers in our practice. 30% of PCPs and 28% of PSPs met our predetermined definition of exhibiting signs of burnout,
p
= 0.711. This rate appears to be lower than those reported in recent national survey data of all physicians. Despite these rates of burnout and feeling stress at work, only 9% of PCPs and 16% of PSPs scored low for the MBI’s personal accomplishment subscore. In addition, in the PSPs, there was a statistically significant difference in prevalence of low personal accomplishment in those who are experiencing at least one manifestation of burnout (36%), compared to those who are not experiencing at least one manifestation of burnout (8%). That difference was not significant in the PCP cohort (13% in burnout cohort vs. 8% in non-burnout cohort).
Conclusions
The results have already proven useful in shaping our approach to improving provider wellbeing and mitigating burnout. It is important that healthcare organizations measure rates of provider burnout and develop strategies to tackle this vital issue.
Journal Article
The air they breathe: a pediatrician on the frontlines of climate change
\"In the Air They Breathe, Dr. Hendrickson recounts patients she's seen who were harmed by worsening smoke, smog, and pollen. The climate crisis is a health crisis, and it is a health crisis first and foremost for children.\" -- adapted from book jacket.
Book
Patient perspectives on how physicians communicate diagnostic uncertainty
Abstract
Objective
We evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction.
Design/Setting
Experimental vignette-based study design involving pediatric cases presented to a convenience sample of parents living in a large US city.
Participants/Intervention(s)
Three vignettes were developed, each describing one of three different ways physicians communicated diagnostic uncertainty to parents—(i) explicit expression of uncertainty (‘not sure’ about diagnosis), (ii) implicit expression of uncertainty using broad differential diagnoses and (iii) implicit expression of uncertainty using ‘most likely’ diagnoses. Participants were randomly assigned to one of the three vignettes and then answered a 37-item web-based questionnaire.
Main Outcome Measure(s)
Outcome variables included parent-perceived technical competence of physician, trust and confidence, visit satisfaction and adherence to physician instructions. Differences between the three groups were compared using analysis of variance, followed by individual post hoc analyses with Bonferroni correction.
Results
Seventy-one participants completed the vignette questions. Demographic characteristics and scores on activation (parent activation measure [PAM]) and intolerance to uncertainty were similar across the three groups. Explicit expression of uncertainty was associated with lower perceived technical competence, less trust and confidence, and lower patient adherence as compared to the two groups with implicit communication. These latter two groups had comparable outcomes.
Conclusion
Parents may react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses. Evidence-based strategies to communicate diagnostic uncertainty to patients need further development.
Journal Article