How do you approach parents who refuse pediatric vaccines?

Specialties NP

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I'm an FNP student doing my peds clinicals now. I'm amazed at the number of parents who casually refuse vaccines that could make a huge difference in their children's lives. HPV is one; flu is another. There seems to be a baseline suspicion about vaccines that make some parents not think twice about saying no. I find that refusing does not follow any social pattern; I see it in both younger and older patents, wealthy and underserved, well-and less educated. One exception seems to be immigrants. I find that those parents are less likely to refuse, possibly because, in some cases, they actually see the ravages of the diseases that we try to immunize against. This is completely an anecdotal finding on my part.

Do you support patents who refuse to immunize? Challenge them? Educate them?

Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
For right or wrong that is the provider's prerogative. I have only abruptly cut ties twice; once was a patient that forged a script and another was a failed drug test narcotic user that got nasty with my staff.

You are absolutely correct that it is their prerogative. I just don't think it really helps anyone or is really in the best interest of the patient. We won't always agree with our patients. Do we cut them off over this? There are big things to cut people off for...like your 2 examples. I just think it is sad to cut a patient off over a difference of opinion on vaccines knowing that it could mean the patient ends up with no medical provider. Why not continue to keep the patient and kindly work on education and changing their opinion?

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Specializes in Adult Internal Medicine.
You are absolutely correct that it is their prerogative. I just don't think it really helps anyone or is really in the best interest of the patient. We won't always agree with our patients. Do we cut them off over this? There are big things to cut people off for...like your 2 examples. I just think it is sad to cut a patient off over a difference of opinion on vaccines knowing that it could mean the patient ends up with no medical provider. Why not continue to keep the patient and kindly work on education and changing their opinion?

Because you view them as a danger to your other patients. This isn't as big of a concern in adults as it is in pediatrics.

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Because you view them as a danger to your other patients. This isn't as big of a concern in adults as it is in pediatrics.

But are they truly an immense age danger in your office? Not anymore than out in public where they might never change their mind without a provider. I think those who are more open minded and accepted have the greater chance of changing minds. Pound chest...patient leaves and vaccines never happen. Educate and treat and educate and treat...patient has the opportunity to change their mind.

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That seems excessive! I'm all for vaccines but they do carry real, albeit rare, risks. It's up to parents to make an informed decision and providers to ensure parents are properly informed but not to coerce compliance. What next, cardiologists discharging pts who don't want invasive procedures?

Signing away one's autonomy for medical care = :no:

That does happen, more than people realize. Decades ago, in the southern city in which I went to nursing school, the leading cardiac surgeon in the region announced publicly that he was no longer going to operate on smokers, as he had decided it was a waste of his time and effort. Caused a huge uproar, esp. since this was in the heart of tobacco country. But it is the provider's perogative, and that surgeon stuck by his position.

I don't see this as being about "coercing compliance." What about the provider's "autonomy"? If you are a provider and recommend the treatment that you sincerely feel is in the client's best interests and the best available treatment for the individual's health issues, and the client declines that treatment, what are you supposed to do?

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
That does happen, more than people realize. Decades ago, in the southern city in which I went to nursing school, the leading cardiac surgeon in the region announced publicly that he was no longer going to operate on smokers, as he had decided it was a waste of his time and effort. Caused a huge uproar, esp. since this was in the heart of tobacco country. But it is the provider's perogative, and that surgeon stuck by his position.

I don't see this as being about "coercing compliance." What about the provider's "autonomy"? If you are a provider and recommend the treatment that you sincerely feel is in the client's best interests and the best available treatment for the individual's health issues, and the client declines that treatment, what are you supposed to do?

Work with them? I can't imagine providers saying "you don't agree with me so we are done" on a large number of topics working out well. For example...woman in ICU right now who is intubated. She has kidney cancer with mets to bone, lungs and likely brain (or more). She has a colostomy bag not working. She is not responsive and not sedated. Her BP is normal with a cardizem drip. She is in early renal failure. Some labs...albumin 1, WBC and bands increased. Significant swelling from the neck down. Oh and MRSA.

Family says "she's a fighter". Medical team thinks family is delusional. Does medical team walkaway because the family is delusional? No they work with them. They continue to provide treatment (including blood) that they know isn't going to work.

This is the same idea. This time the family is wasting resources.

So what are you supposed to do? Provide care while continuing to educate and hope for the outcome you are working towards. I bet more kids would get vaccinated, eventually, if the provider maintained the relationship and continued to educate the parents in the case of vaccines.

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Family says "she's a fighter". Medical team thinks family is delusional. Does medical team walkaway because the family is delusional? No they work with them. They continue to provide treatment (including blood) that they know isn't going to work.

This is the same idea. This time the family is wasting resources.

And this scenario is happening all over the country and is one of the reasons US healthcare costs are so high -- futile treatment because family insists and hospital and physicians are afraid of getting sued.

I'm not suggesting a universal "it's my way or the highway" approach. I'm all about a collaborative approach to care. But I also don't think badly of physicians and other providers who feel that they are unable to function in a professional relationship with particular individuals and, therefore, cannot continue in that relationship, because of positions taken by the clients. Like so many situations in life, it cuts both ways.

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Specializes in Adult Internal Medicine.
But are they truly an immense age danger in your office? Not anymore than out in public where they might never change their mind without a provider. I think those who are more open minded and accepted have the greater chance of changing minds. Pound chest...patient leaves and vaccines never happen. Educate and treat and educate and treat...patient has the opportunity to change their mind.

New study just published in Pediatrics today, you should read it re: providing patients with education about vaccines.

Effective Messages in Vaccine Promotion: A Randomized Trial

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
New study just published in Pediatrics today you should read it re: providing patients with education about vaccines. Effective Messages in Vaccine Promotion: A Randomized Trial[/quote']

I get that for some it won't work. This study was very small and very specific. I just don't think putting a patient into the streets without care is a good idea. There are lots of offices here who won't take patients who won't vaccinate. I also know many parents who just want a different schedule and they too are pushed out. There's no hope of vaccination if they don't have care.

Id like a study that actually looks at parents who weren't going to vaccinate and maintained relationships with the ped...if in time they changed their mind.

No vaccines does equal no provider in some areas...and I find that very concerning as there is more to care than vaccines.

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and in all likelihood, the ED becomes the pcp....

I get that for some it won't work. This study was very small and very specific. I just don't think putting a patient into the streets without care is a good idea. There are lots of offices here who won't take patients who won't vaccinate. I also know many parents who just want a different schedule and they too are pushed out. There's no hope of vaccination if they don't have care.

Id like a study that actually looks at parents who weren't going to vaccinate and maintained relationships with the ped...if in time they changed their mind.

No vaccines does equal no provider in some areas...and I find that very concerning as there is more to care than vaccines.

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
and in all likelihood the ED becomes the pcp....[/quote']

And that's exactly what I was thinking...and we all know that's not truly acceptable.

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