Use of standardized patients to examine physicians' communication strategies when addressing vaccine refusal: a pilot study.

Vaccine refusal is increasingly reported but few direct observations of the communication between physicians and parents skeptical about vaccines have been made. In a pilot study, a standardized patient posing as an expectant mother (standardized mother, SM) opposed to immunization met with blinded community physicians under the pretext of prenatal interviews. Persuasive communication strategies were scored using a standardized questionnaire. Recorded transcripts were evaluated for compliance with American Academy of Pediatrics recommendations for handling vaccine refusal. Nine encounters were conducted, representing 16% of pediatric and 3% of family practices in the area. Physicians scored high on listening, maintaining eye contact, spending time with the SM, using understandable terms, and avoiding a paternalistic posture. Lower scores were obtained on encouraging questions, checking for understanding, validating the importance of the SM's concerns, and assessing knowledge about vaccines. The median recorded encounter lasted 19 min. SMs represent a novel strategy for studying physician/parent communication about vaccines.