Empathy in Vaccination Counselling: A Survey on the Impact of a Three-day Residential Course

"Empathy may be a natural talent, but specific techniques can be learned through courses, lectures, and workshops to acquire or improve the ability to understand and share emotions."

There is evidence that providing hesitant parents with detailed information about the benefits of immunisation is not sufficient to address their concerns. It has been shown that effective communication requires an empathic approach by the healthcare provider, who should understand parents' beliefs and concerns about vaccines, tailoring the counselling to the family's perspective and sociocultural context. There are professional skills that can be improved through professional training, something that is progressively being implemented in the academic teaching and continuing medical education of healthcare professionals in several countries. This study aimed to assess the impact of a 3-day residential course on empathy and counselling abilities on the parent-rated level of empathy of healthcare staff working in vaccination centres in the south of Italy. Empathy was measured using the Consultation and Relational Empathy (CARE) Measure, whose application to the vaccination field was tested through the study.

In June 2015, the healthcare workers (9 medical doctors and 11 nurses) attended a 3-day residential course based on the Rogersian model, which had the goal to improve the quality of the relationship between the provider and the patients during the vaccination process within a family and patient-centred care (PFCC) approach. The rationale is that applying empathy in a vaccination centre (which basically means being interested in parents and children as whole people, listening to them, and understanding their expectations and concerns about vaccination) may help the provider to effectively support parents in making conscious choices about vaccines, preserving their autonomy. The course had 4 sections lasting 4 or 5 hours each: 1) What is the PFCC and why it is worthwhile. 2) How to improve listening skills. 3) How to improve empathy, including the following sub-sections: a) the importance of the subjective perspective of pain and illness; b) how to overcome barriers to effective communication given by personal judgments or cultural differences. 4) How to communicate correctly about vaccines, including the following subsections: a) providing information about vaccine benefits and side effects; b) dealing with misinformation and prejudices; c) creating a plan of action with parents for future vaccinations.

After the course, between July and August 2015, the healthcare providers administered a validated questionnaire to 50 consecutive parents each; they had administered this same questionnaire prior to the 3-day course. It was based on the CARE Measure, developed in the United Kingdom (UK) and validated in several countries and fields of medicine. The CARE Measure includes 10 items on empathic relationship, with response options based on a 5-point scale with scores from poor to excellent and a "not applicable" option.

The researchers collected 950 pre-intervention and 950 post-intervention questionnaires from 11 nurses and 8 out of 9 doctors. Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. The researchers found higher rates of empathy in nurses than in doctors: Nurses had a better score pre-course, probably due to their more frequent interaction with parents and children; these differences disappear in the post-course evaluation. It seems, therefore, that a residential course may be effective in increasing healthcare professionals' empathy regardless of the starting level.

The success of this residential course in improving patient-rated empathy of doctors and nurses working in vaccination centres suggests a natural development of the present work: a study of the impact of counselling courses on vaccination uptake.