Playing your CARDs right to help patients get over fear of vaccination needles

While a majority of Canadians are eagerly rolling up their sleeves to get vaccinated against COVID-19, there are those who are hesitant—not because they don’t believe in vaccines, but because they harbour a fear of needles. Dr. Anna Taddio (PhD), a pharmacy professor at the University of Toronto and a specialist in pain management, has done extensive research on needle fears and immunization. She says it's critical to address needle fear to get as many people as possible vaccinated against COVID-19. “For fear of needles alone, current estimates are that 5% to 10% of people do not get vaccinated because of these concerns,” she said, adding that up to 25% have some level of needle fear. “So if we can help remove this barrier, people who otherwise have no objections will be vaccinated.” In 2019, Taddio and researchers at the University of Toronto and the Hospital for Sick Children teamed up with educators, public health practitioners and Grade 7 students in Ontario to develop a new way to deliver school-based vaccines. The result is the CARD system (Comfort, Ask, Relax, Distract), an evidence-based approach that's now being promoted across the country as a way to deal with vaccine fears and phobias for both children and adults during the COVID-19 vaccination campaign. Healthcare providers are encouraged to let patients know about this system beforehand, and talk about it with patients when needed during vaccination: Taddio summarizes the method and its strategies that healthcare providers can share with their patients: C for COMFORT: “Think of ways that make you comfortable. For example, wear a short-sleeved shirt or one with sleeves that are easy to pull up to make vaccinations easier and faster. If you get dizzy during needles, squeeze your legs together.” A for ASK QUESTIONS: “People are anxious when they do not have enough information. Questions from children and adults will be different. Kids might be more concerned about how to take away the pain of the needle, and adults might be more concerned about side-effects that happen afterward. But they should both be encouraged to ask questions to be prepared. Asking questions can also lead to discoveries like learning about topical anesthetics.” R for RELAX: “Think of ways that make you calm. Some examples of strategies people use to stay calm include taking deep belly breaths (like blowing a balloon), having a support person with them, or getting vaccinated in private (out of view of others).” D for DISTRACT: “Some people like to take their mind away from what’s happening and this can reduce their worries. Electronic devices like cell phones are a popular way to get distracted. But you can also have conversations with someone about things that make you happy. With CARD, everyone chooses the letters they want to play—there’s no wrong move.” “Letting everyone know ahead of time about CARD sets up a more positive interaction because patients are prepared and they know their needs and preferences are being respected,” Taddio said. Once healthcare providers are with a patient, Taddio suggests they open the conversation with something like, “Some people are nervous about needles and others are not. On a scale of 0 to 10, how nervous are you?” This opens the door to then being able to help patients with the procedure, answering any questions they have, accommodating coping requests or applying the CARD system, she said. For patients with a severe phobia, Taddio recommends they be referred to a mental health expert to address the root cause and become desensitized to the fear. Taddio and her colleagues are using multiple strategies to get the word out about CARD, including providing information to healthcare providers to share with patients (e.g., via provincial and national networks such as Immunize Canada, ministries of health, BC CDC and university curriculum and continuing medical education), providing information via websites (e.g., Immunize.ca, Kidshealthfirst.ca, BC CDC, Anxiety Canada), education of children, families and schools (e.g., Kidsboost Immunity) and news and social media.

Playing your CARDs right to help patients get over fear of vaccination needles

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