ABSTRACT

Presented at the 37th National Immunization Conference, Chicago, IL, March 17, 2003

RISK COMMUNICATION AND PEDIATRICIAN RESPONSES TO VACCINE REFUSALS

Geoffrey Evans, National Vaccine Injury Compensation Program, HRSA, Department of Health & Human Services, 5600 Fishers Lane, Room 8A-46, Rockville, MD; Karen G. O'Connor, Division of Health Policy Research, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL; and Julie Kersten Ake, Division of Health Care Finance and Practice, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL.

KEYWORD:
Vaccine refusal, risk communication, documentation.

BACKGROUND:
Communicating risks and benefits of immunizations and educating parents on vaccine preventable diseases and safety are important goals in patient care.

OBJECTIVE:
Assess pediatricians' practices regarding documentation of vaccine refusals and other methods of handling parental declination of vaccines for their children.

METHODS:
National random sample, mailed Periodic Survey of American Academy of Pediatrics members in 1990 (response rate=73%, n=519) and 2001 (response rate=64%, n=815).

RESULT:
In 2001 about seven out of ten pediatricians report that in the past 12 months, they had a parent refuse permission for a vaccination due to safety concerns; MMR was the vaccine most frequently refused. In 2001 nearly all pediatricians (96%) report attempting to educate refusing parents on the importance of vaccination, risk of vaccine preventable diseases and vaccine safety issues. If parents continue to withhold permission for a vaccine, few pediatricians (5%) routinely refuse to continue to be that patient's doctor, although an additional 18%sometimes do so. Nearly 80% of these pediatricians cite lack of trust as the primary reason for terminating the physician-patient relationship. In 2001 as in 1990, the percentage of pediatricians who document refusals in the patient's chart (96%, 96%), document the provision of risk benefit information (72%, 74%) and obtain the parent's signature (24%, 20%) is about the same.

CONCLUSION:
Documentation of the provision of risk communication, informed refusals and parental signature remains consistent from 1990 to 2001. While most pediatricians keep patients whose parents decline immunizations in their practices, a small proportion do not, primarily due to diminution of trust.