While the number of people getting vaccinations for their children is relatively stable,1 some parents and guardians are hesitant about or refuse vaccines, or they want to depart from the recommended schedule. Researchers have identified seven primary reasons for this:2,3,4
- Fear that vaccines cause autism (or another chronic disabling condition)
- Fear that vaccines contain toxic ingredients
- Concern that vaccines have not been thoroughly tested
- Fear that a child’s natural immune system could be weakened by vaccines
- Concern that too many vaccines are given at one time
- Adherence to religious or philosophical beliefs that reject vaccines or other medical care
- Trust in their own research above physicians’ recommendations
More Information About Adolescent Consent and Privacy
The following resources provide information about additional areas of adolescent treatment that practices often find challenging relative to the consent process:
- Case Study: Consent for Treatment of an Adolescent: Drug Testing
- Case Study: Consent for Treatment of an Adolescent: Unaccompanied Adolescents
- Case Study: Consent for Treatment of an Adolescent: Third-Party Consent
- Case Study: Parental Access to Adolescent Patient Portals
- Case Study: Adolescent Health Information: Is it Confidential?
- Article: Adolescent Health Information Privacy
- Article: Consent for Treatment of an Adolescent: When Divorced Parents Disagree
Enhancing the Consent Process
Physicians should be ready to address these concerns when discussing vaccinations with parents. It’s an opportunity to educate about the benefits, risks, and alternatives associated with scheduled immunizations; address concerns; and facilitate wider vaccine acceptance.
The NORCAL Special Report, “Strategies for Addressing Parental Concerns About Vaccination,” delves into this issue and offers discussion strategies.
In addition, physicians should incorporate the following into their immunization consent process:
- Provide vaccine information statements (VIS).
- Document the edition date of the VIS and the date given.
- Document required information (per 42 USC §300aa-25):
- Date vaccine administered
- Vaccine manufacturer and lot number
- Name, address, and (if appropriate) title of provider administering the vaccine
If a parent refuses to have his or her child immunized, explain the risks associated with refusal, and document the discussion and the parent’s understanding in the child’s chart. You can also ask the parent to sign a form.
NORCAL Group policyholders can obtain the sample form “Refusal to Consent to Vaccination” in the MyACCOUNT policyholder portal or by contacting NORCAL Risk Management.
Approach Termination of the Relationship with Caution
If parental attitudes and behaviors about vaccination or other issues have become strident and caused clashes that have harmed the physician-patient relationship, it may be prudent to end the association with the patient/parents. Although the American Academy of Pediatrics (AAP) acknowledges that termination might be necessary in some circumstances, it recommends physicians exercise caution if they are contemplating termination of their relationships with patients whose parents refuse vaccinations.5
1. Holly A. Hill, et. al. “Vaccination Coverage Among Children Aged 19–35 Months-United States, 2017.” Morbidity and Mortality Weekly Report (MMWR). 2018;67:1123–1128
2. Margie Danchin, et. al. “A Positive Approach to Parents with Concerns About Vaccination for the Family Physician.” Australian Family Physician. 2014;43(10):690-4.
3. Douglas J. Opel, et al. “Development of a Survey to Identify Vaccine-Hesitant Parents: The Parent Attitudes About Childhood Vaccines Survey.” Human Vaccines. 2011;7(4):419–425.
4. Fay A. Rozovsky. “Of Consent, Informed Refusal, and Measles Vaccination.” Journal of Healthcare Risk Management. 2015;35(1):37-41.
5. Kathryn M. Edwards, et. al. “Countering Vaccine Hesitancy.” Pediatrics. 2016; 138(3).