Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule

Abstract

OBJECTIVES To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children <2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests. METHODS An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012. RESULTS The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children <2 years requested to spread out vaccines; 21% reported ≥10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective. CONCLUSIONS Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.

Vaccination uptake by vaccine-hesitant parents attending a specialist immunization clinic in Australia

“…Furthermore, over half (54%) of pediatricians reported an increased workload as a result of requests for selective vaccination schedules by parents. 33 These trends highlight the need for more specialist referral services to which PCP's can refer families with higher degrees of hesitancy, vaccination knowledge or more complex concerns or requests, such as selective vaccinations schedules. SIC's also able to provide longer appointments and vaccination facilities for these families.…”

“…However, a recent survey of pediatricians and family physicians in the US suggested that one third of respondents acquiesced to parental requests for delayed and/or separated vaccinations in the interest of maintaining a therapeutic relationship with the family. 33 This was despite the majority of respondents acknowledging that this placed both the child and community at greater risk of harm from VPD's. 33 The combination of physicians' reported futility in dealing with these requests and the high frequency of this outcome reported in our study emphasize the need for development and training in optimal communication approaches for these discussions.…”

“…33 This was despite the majority of respondents acknowledging that this placed both the child and community at greater risk of harm from VPD's. 33 The combination of physicians' reported futility in dealing with these requests and the high frequency of this outcome reported in our study emphasize the need for development and training in optimal communication approaches for these discussions.…”

Countering Vaccine Hesitancy

“…9 Although the majority of parents accept vaccines, the increasing frequency of refusal and the requests for alternative vaccine schedules indicate that there are still significant barriers to overcome. 10 …”

Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial

“…[1][2][3] As public confidence in vaccines erodes, [4][5][6][7] parents hesitate about vaccine decisions, vaccination rates may decrease, and outbreaks of vaccinepreventable disease may be more likely. [8][9][10][11] Physicians are highly influential on parental beliefs and attitudes about childhood vaccinations, 7,12-14 yet many feel unprepared to address questions from vaccine-hesitant parents.…”