Physician Communication Training Research Articles

C-reactive protein point-of-care testing in primary care-broader implementation needed to combat antimicrobial resistance.

This study presents the perspective of an international group of experts, providing an overview of existing models and policies and guidance to facilitate a proper and sustainable implementation of C-reactive protein point-of-care testing (CRP POCT) to support antibiotic prescribing decisions for respiratory tract infections (RTIs) with the aim to tackle antimicrobial resistance (AMR). AMR threatens to render life-saving antibiotics ineffective and is already costing millions of lives and billions of Euros worldwide. AMR is strongly correlated with the volume of antibiotics used. Most antibiotics are prescribed in primary care, mostly for RTIs, and are often unnecessary. CRP POCT is an available tool and has been proven to safely and cost-effectively reduce antibiotic prescribing for RTIs in primary care. Though established in a few European countries during several years, it has still not been implemented in many European countries. Due to the complexity of inappropriate antibiotic prescribing behavior, a multifaceted approach is necessary to enable sustainable change. The effect is maximized with clear guidance, advanced communication training for primary care physicians, and delayed antibiotic prescribing strategies. CRP POCT should be included in professional guidelines and implemented together with complementary strategies. Adequate reimbursement needs to be provided, and high-quality, and primary care-friendly POCT organization and performance must be enabled. Data gathering, sharing, and discussion as incentivization for proper behaviors should be enabled. Public awareness should be increased, and healthcare professionals' awareness and understanding should be ensured. Impactful use is achieved when all stakeholders join forces to facilitate proper implementation.

Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics

BackgroundMultiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination.MethodsUsing 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months.ResultsConcept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the “go-zone” for action, with three from “reducing missed opportunities,” two from “nurse/staff workflow and training,” and one each from “provider tracking/audit and feedback,” “provider recommendation/communication,” and “expanding vaccine access,” which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes).ConclusionsConcept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.

Development and pilot test of a physician-focused cancer clinical trials communication training intervention

We describe the development and pilot test of a physician-focused, web-based training module designed to improve physician communication related to clinical trials in a diverse cancer patient population. Researchers and stakeholders developed the training module, which included a video explaining patient-centered communication strategies for discussing trials, and re-enactments of actual clinical interactions. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two major urban cancer centers. Questionnaires assessed change in beliefs, behavioral attitudes, knowledge and comfort; and perceptions of the module. Nineteen physicians participated in the pilot test. Most were experienced in discussing trials. Assessments of change were mixed regarding beliefs; they showed marginal improvement in attitudes, and significant improvement in knowledge, but no change in comfort. Feedback on the module was favorable. This stakeholder-developed physician communication training module was acceptable and effective, albeit in this small and highly-experienced physician sample. Future research should determine its effectiveness on communication in clinical settings. This is the first physician training module to focus on communicating about clinical trials in a diverse patient population. It offers a web-based format and re-enactments of naturally-occurring clinical interactions. Trial Registration Number: NCT02906241

Parent-Provider Communication in Hospitalized Children with Advanced Heart Disease

Communication between parents and providers of children with cardiac disease is essential to parental decision-making. This study explored how parents of hospitalized children with advanced heart disease perceived communication with their child's providers. We performed a prospective survey study of parents and physicians of children with advanced heart disease age 30days to 19years admitted to the hospital for > 7days over a 1-year period at a single institution (n = 160 parent-provider pairs). Descriptive statistics were primarily used and Fisher exact tests and kappa statistics were used to assess agreement. All parents rated communication with their child's care team as excellent, very good, or good, but 56% of parents reported having received conflicting information. Parental perception of "too many" people giving them information was associated with overall poorer communication and less preparedness for decision-making. One-third (32%) of parents felt unprepared for decision-making, despite 88% feeling supported. Parents and physicians showed poor agreement with respect to overall adequacy of communication, receipt of conflicting information, and evaluation of the most effective way for parents to receive information. Interventions involving physician communication training and proactive assessment of parent communication preferences may be beneficial.

Effective Approaches to Combat Vaccine Hesitancy.

Effective Approaches to Combat Vaccine Hesitancy.

Implementation of quality improvement coaching versus physician communication training for improving human papillomavirus vaccination in primary care: a randomized implementation trial.

Many US health departments (HDs) conduct in-person quality improvement (QI) coaching to help primary care clinics improve their HPV vaccine delivery systems and communication. Some HDs additionally conduct remote communication training to help vaccine prescribers recommend HPV vaccination more effectively. Our aim was to compare QI coaching and communication training on key implementation outcomes. In a cluster randomized trial, we offered 855 primary care clinics: 1) QI coaching; 2) communication training; or 3) both interventions combined. In each trial arm, we assessed adoption (proportion of clinics receiving the intervention), contacts per clinic (mean number of contacts needed for one clinic to adopt intervention), reach (median number of participants per clinic), and delivery cost (mean cost per clinic) from the HD perspective. More clinics adopted QI coaching than communication training or the combined intervention (63% vs 16% and 12%, both p < .05). QI coaching required fewer contacts per clinic than communication training or the combined intervention (mean = 4.7 vs 29.0 and 40.4, both p < .05). Communication training and the combined intervention reached more total staff per clinic than QI coaching (median= 5 and 5 vs 2, both p < .05), including more prescribers (2 and 2 vs 0, both p < .05). QI coaching cost $439 per adopting clinic on average, including follow up ($129/clinic), preparation ($73/clinic), and travel ($69/clinic). Communication training cost $1,287 per adopting clinic, with most cost incurred from recruitment ($653/clinic). QI coaching was lower cost and had higher adoption, but communication training achieved higher reach, including to influential vaccine prescribers.

Implementation of QI Coaching Versus Physician Communication Training for Improving HPV Vaccination in Primary Care: A Randomized Implementation Trial

Abstract Purpose of study: Health departments (HDs) are at the forefront of efforts to improve HPV vaccine uptake in the US. Most notably, HD staff routinely conduct in-person quality improvement (QI) coaching to help primary care clinics improve their vaccine delivery systems. Some HDs also engage outside experts to conduct remote physician communication training to help vaccine prescribers recommend HPV vaccine more effectively. To guide future HD programming, we sought to understand the implementation strengths and challenges of QI coaching and physician communication training. Methods: In a cluster randomized trial, we allocated 855 primary care clinics in 3 geographically-diverse US states to receive: 1) QI coaching; 2) physician communication training; or 3) both interventions combined. In each arm, we assessed adoption (or the % of clinics receiving the allocated intervention out of those invited), contacts per clinic (mean number of contacts needed to successfully schedule one clinic), reach (median number of total staff and prescriber participants per clinic), and delivery cost. Results: More clinics adopted QI coaching than communication training or the combined intervention (63% vs 16% and 12%, both p&amp;lt;.05). Recruiting clinics into QI coaching sessions required fewer contacts than communication training or the combined intervention (mean = 4.7 vs 29.0 and 40.4, both p&amp;lt;.05). In contrast, communication training and the combined intervention reached more total staff per clinic than QI coaching (median = 5 and 5 vs 2, both p&amp;lt;.05), including more prescribers per clinic (2 and 2 vs 0, both p&amp;lt;.05). QI coaching cost $439 per clinic on average, including costs incurred from follow up ($129/clinic), session preparation ($73/clinic), and travel ($69/clinic). Communication training cost $1,287 per clinic, with most cost incurred from clinic recruitment ($653/clinic). Conclusions: QI coaching was lower cost and had higher adoption, but remote communication training achieved higher reach, including to highly influential vaccine prescribers. Thus, communication training is a promising intervention for improving HPV vaccine delivery, although care will be needed to overcome substantial challenges to clinic recruitment.

Does Coaching Hospitalists in a Community Hospital Improve the Measured Experience of Care?

Hospitals initiate physician communication training programs expecting to improve patient experience measures. However, most efforts have relied on methods with limited attention to bedside physician–patient interactions. We conducted an intensive in-person hospitalist coaching program to improve patient experience in a community hospital. Full-time hospitalists were coached twice monthly by physician-coaches using a structured process featuring direct observation of care and immediate recommendations. Coach-observed care measures improved marginally. Difference-in-differences analysis of 1137 Hospital Consumer Assessment of Healthcare Providers and Systems surveys revealed no significant improvements by trained hospitalists in preintervention versus intervention comparisons, calling into question the strategy of using coaching programs to improve hospitals’ doctor communication measures.

What is clinical empathy? Perspectives of community members, university students, cancer patients, and physicians

ObjectivesTo explore what undergraduates, community members, oncology patients, and physicians consider empathic behavior in a physician. Methods150 undergraduates, 152 community members, 95 physicians, and 89 oncology patients rated 49 hypothetical physician behaviors for how well they fit their personal definition of physician empathy. Dimensions of empathy were explored and compared across groups. ResultsThree dimensions of empathy were Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. Relationship Oriented was the most strongly endorsed, followed by Emotionally Involved, with Conscientious and Reassuring coming in last. There were no group differences for Conscientious and Reassuring, but the Relationship Oriented factor was more endorsed by the clinical groups (physicians and patients) than the non-clinical groups. The Emotionally Involved factor was endorsed by physicians notably more than by patients. ConclusionWhat is considered clinical empathy is not the same across individuals and stakeholder groups. Practice ImplicationsPhysicians and patients differ in how much they include the physicians’ emotionality and emotion-related actions in their definition of empathy. Communication training for physicians that emphasizes behaviors associated with empathy (listening, understanding a person’s feelings and perspectives, and showing interest in and concern for the whole person) may enhance patients’ perception of clinical empathy.

Physician-patient communication: a qualitative study of perceptions, barriers, and needs in four European member states

ABSTRACT Background: Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes, however, there is a lack of standard European Union (EU) communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded project, Health Communication Training for Health Professionals – H-COM. Method: Focus groups were conducted with 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Two separate discussion guides were constructed for each target group around three themes: perceptions of, barriers to, and needs for health communication. Thematic analysis was used. Results: Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Participants indicated a significant gap in health communication knowledge, skills, and training for physicians, with regional differences. Conclusion: The results imply that there is a need for EU-wide communication training for physicians that would be best addressed by common themes and tailoring to specific regional differences. The results also imply that effective training should encompass a blend of theory and practical methods, and should be delivered via an e-learning platform for maximum accessibility. Training programs that adhere to these suggestions can begin to address the gaps in patient-centered care in the EU.

Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial

BackgroundImproving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP).MethodsA randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus –Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests.ResultsAfter the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group.ConclusionThe educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients.Trial registrationIranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].

Physician-patient communication: A qualitative study of perceptions, barriers, and needs in 4 EU MS

Abstract Background Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes. However there is a lack of standard EU communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded Project “H-COM”, Health Communication Training for Health Professionals. Methods Eight focus groups were conducted with a total of 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Three themes were covered; perceptions, barriers and needs for health communication. Results Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Identified barriers among patients include a deeply embedded hierarchical notion and arrogance among physicians, inadequate or difficult to understand language, busy schedules. Among doctors barriers identified were mostly systemic having to do with busy schedules, large number of patients, and lack of time. Participants especially patients indicated a significant gap in health communication knowledge, skills, and training for physicians, with several regional differences being present especially between Mediterranean and central European countries. Conclusions The results imply a strong need for communication training, tailored accordingly in specific countries. Further development of policies related to the inclusion of such training in medical studies across EU would be of great importance. Key messages There are differences concerning health communication needs and barriers between EU regions and the development of tailored training. Although identified as important there is a lack of health communication training in certain EU MS and an urgent need to incorporate training in basic medical and nursing education.

Potential utility of an independent decision-making board for seriously ill patients lacking decisional capacity

Summary Physicians acknowledge that they are providing unnecessary medical care at the end of life for a variety of reasons, including fear of malpractice litigation, Medicare's fee-for-service reimbursement mechanism, patient and family requests for care, a culture of denial of mortality, and a physician culture which views a patient's death as a professional failure. Recent data suggest that more than one-fifth of medical care provided at the end of life is unnecessary. Although the problem of over-provision of medical care is now well recognized in the legal and medical literatures, private-ordering solutions, such as better communication training for physicians or improved patient decision aids, will have only marginally ameliorating effects. The inherent challenges in making medical decisions during terminal illness become even more complex when patients are unable to make these choices for themselves. Although patient autonomy, implemented via informed consent, is the primary principle that governs medical decision-making, including on behalf of patients who have lost decisional capacity, insufficient evidence of the patient's wishes coupled with uncertainty about prognosis often leaves physicians and family members in a quandary as to whether to implement or to continue providing therapeutic treatment or life-prolonging care. The default operation of the surrogate consent process in the U.S. means that, for patients who do not clearly opt out of life-prolonging treatment before losing decisional capacity, the path of least resistance often will lead to decisions in favour of initiating or continuing life-prolonging care. This state of affairs can lead to substantial stress for all parties concerned, along with the potential for conflict. This paper considers the potential utility and transplantability of a Canadian public decision-support mechanism in this context. In 1996, the provincial government of Ontario implemented a Consent and Capacity Board (CCB), an independent expert body charged, among other things, to mediate and resolve disputes in the context of surrogate decision-making. Two-plus decades of CCB evidence suggest this it provides a better shared, less confrontational and more robust decision-making process than is currently available within the U.S. surrogate decision-making rules. Thus, a CCB type mechanism has the potential to also improve surrogate decision-making at the end of life in the U.S. and this paper discusses the extent to which it is capable of being “transplanted” into the U.S. health system on a state-by-state basis.

Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial

ABSTRACTObjective: Adverse cross-cultural interactions are a persistent problem within medicine impacting minority patients' use of services and health outcomes. To test whether 1) enhancing the evidence-based Physician Asthma Care Education (PACE), a continuing medical education program, with cross cultural communication training (PACE Plus) would improve the asthma outcomes of African American and Latino/Hispanic children; and 2) whether PACE is effective in diverse groups of children. Methods: A three-arm randomized control trial was used to compare PACE Plus, PACE, and usual care. Participants were primary care physicians (n = 112) and their African American or Latino/Hispanic pediatric patients with persistent asthma (n = 867). The primary outcome of interest included changes in emergency department visits for asthma overtime, measured at baseline, and 9 and 21 months following the intervention. Other outcomes included hospitalizations, asthma symptom experience, caregiver asthma-related quality of life, and patient-provider communication measures. Results: Over the long term, PACE Plus physicians reported significant improvements in confidence and use of patient-centered communication and counseling techniques (p < 0.01) compared to PACE physicians. No other significant benefit in primary and secondary outcomes was observed in this trial. Conclusion: PACE Plus did not show significant benefit in asthma-specific clinical outcomes. More trials and multi-component strategies continue to be needed to address complex risk factors and reduce disparities in asthma care.Trial registration: ClinicalTrials.gov: NCT01251523 December 1, 2010.Trial registration: ClinicalTrials.gov identifier: NCT01251523.

Exploring Habermas’ theory of communicative ethics as an approach to physician communication training: the case of pediatric end-of-life care

In pediatric end-of-life (EOL) care, the partnership between physicians and parents is principally centered on communication and the parents’ decision-making role about the patient’s impending death. And, because parents are charged with EOL decision-making for their children, physicians are morally responsible to ensure that prognoses and treatment options are communicated to parents in a comprehendible way. Poor communication has been posited as a primary reason why the end-of-life (EOL) wishes of patients and surrogates are not implemented. This paper is based on findings from a qualitative study that utilized observation in a high-fidelity simulation and semi-structured interviews with physicians to explore narrative influences on pediatric EOL communication. The findings of this study, which revealed an inherent connection between communication, decision-making, and ethics, are reflected Habermas’ theory of Communicative Ethics (The theory of communicative action: reason and the rationalization of society, Beacon Press, Boston, 1984; The theory of communicative action: lifeworld and system: a critique of functionalist reason, Beacon Press, Boston, 1987). Therefore this paper proposes communicative ethics as an important model which, if utilized in physician education and training, could improve physician communication and in particular, physician–parent EOL communication.

A Communications Bundle to Improve Satisfaction for Critically Ill Patients and Their Families: A Prospective, Cohort Pilot Study

ContextCommunication skills training with simulated patients is used by many academic centers, but how to translate skills learned in simulated settings to improve communication in real encounters has not been described. ObjectivesWe developed a communications bundle to facilitate skill transfer from simulation to real encounters and improve patient and/or family satisfaction with physician communication. We tested the feasibility of its use in our hospital's medical intensive care unit (MICU). MethodsThis prospective cohort 2-week feasibility study included patients admitted to the MICU with APACHE IV predicted mortality >30% and/or single organ failure. The communications bundle included simulation communication training for MICU physicians, scheduling a family meeting within 72 hours of MICU admission, standardized pre- and post-meeting team huddles with the aid of a mobile app to set an agenda, choose a communication goal, and get feedback, and documentation of meeting in the electronic medical record. The intervention group receiving the communications bundle was located in a geographically separate unit than the control group receiving standard of care from MICU physicians who had not received training in the communications bundle. Patient satisfaction surveys were given within 48 hours of the family meeting and scores compared between the two groups. We also compared trainee self-perceived communication preparation. ResultsThe intervention group (N = 15) scored significantly higher on satisfaction than the control group (N = 16) (P = 0.018). Intervention group trainees reported improvement in self-perceived communication preparation. ConclusionUse of the communications bundle proved feasible in the MICU and suggests association with improved patient satisfaction and trainee self-perception of communication preparedness.

Promoting conversations between physicians and families about childhood obesity: evaluation of physician communication training within a clinical practice improvement initiative

ABSTRACTChildhood obesity rates have incrementally increased since the 1980s, sparking calls for initiatives focused on addressing this public health concern. In response, the family medicine residency clinic profiled in this research designed, executed, and evaluated a practice improvement initiative focused on physician communication behaviors and clinic processes that impact the management of unhealthy pediatric weight. The results of the evaluation effort demonstrated increased physician knowledge of communication principles, improvements in weight management counseling rates, and opportunities for health delivery system changes to promote the effective clinical management of unhealthy pediatric weight.

Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial.

Physicians have a major influence on parental vaccine decisions. We tested a physician-targeted communication intervention designed to (1) reduce vaccine hesitancy in mothers of infants seen by trained physicians and (2) increase physician confidence in communicating about vaccines. We conducted a community-based, clinic-level, 2-arm cluster randomized trial in Washington State. Intervention clinics received physician-targeted communications training. We enrolled mothers of healthy newborns from these clinics at the hospital of birth. Mothers and physicians were surveyed at baseline and 6 months. The primary outcome was maternal vaccine hesitancy measured by Parental Attitudes on Childhood Vaccines score; secondary outcome was physician self-efficacy in communicating with parents by using 3 vaccine communication domains. We enrolled 56 clinics and 347 mothers. We conducted intervention trainings at 30 clinics, reaching 67% of eligible physicians; 26 clinics were randomized to the control group. Maternal vaccine hesitancy at baseline and follow-up changed from 9.8% to 7.5% in the intervention group and 12.6% to 8.0% in the control group. At baseline, groups were similar on all variables except maternal race and ethnicity. The intervention had no detectable effect on maternal vaccine hesitancy (adjusted odds ratio 1.22, 95% confidence interval 0.47-2.68). At follow-up, physician self-efficacy in communicating with parents was not significantly different between intervention and control groups. This physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy. Research is needed to identify physician communication strategies effective at reducing parental vaccine hesitancy in the primary care setting.

Physician Communication With Vaccine-Hesitant Parents: The Start, Not the End, of the Story.

In this month’s issue of Pediatrics , Henrikson et al1 report a trial of the impact of communication training for physicians on the vaccine hesitancy of parents. The authors found that a physician-targeted communication intervention did not reduce vaccine hesitancy in mothers nor improve physician confidence compared with standard care. However, the study requires careful interpretation and should be seen as the start, not the end, of the story in finding effective approaches to vaccine hesitancy. There is a clear need to develop new approaches to vaccine consultation. Although only 0.7% of children in the United States are completely unvaccinated, an estimated 13% of parents delay or select out of certain vaccines,2,3 and the risk of this choice is enhanced by geographic clustering, creating a critical mass for disease outbreaks.4 Even parents who fully vaccinate have some concerns (eg, the number of vaccines, the vaccine ingredients, whether they potentially “damage” the immune system).5,6 To address vaccination concerns, hesitancy, and refusal, some advocate a tougher line with strong physician recommendation, little room for expression of concern, and even … Address correspondence to Julie Leask, PhD, MPH, Dip App Sci, School of Public Health, Edward Ford Building, A27, University of Sydney NSW 2006, Australia. E-mail: julie.leask{at}sydney.edu.au

Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial

Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial