What constitutes consent when parents and daughters have different views about having the HPV vaccine: qualitative interviews with stakeholders: Table 1

Abstract

While the Gillick guidelines provide a legal framework to help professionals make judgements about adolescents consenting to medical treatment, in practice there appears to be variable and confused interpretation of this guidance. Improved legal structures, management procedures and professional advice are needed to support those who are assessing competence and establishing consent to vaccinate adolescents in a school setting.

Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis

“…Engaging some parents with the consent process could be challenging [46,47,69,70]: “ They couldn ’ t be bothered to read the form or fill it in , you know , motivate themselves enough to do it , but they always wanted the child to have it [ the vaccine ] as long as somebody bothered to knock on the door and say , ‘ just sign on the dotted line ’. It was just the process of the filling of the form in was just too much effort ” [School nurse, UK] [46].…”

“…In the UK, both primary care professionals and school nurses raised concerns about whether the school-setting was appropriate for assessing a young woman’s competence to receive the vaccine without parental consent [59,61,69]: “ If everybody is given 30 seconds to get in and get out , you can ’ t reasonably expect a nurse to make a decision in that time. Yes or no ?…”

“…Yes or no ? They would have to make some sort of later appointment to speak to the young person and have a serious chat which in itself would then single them out from , you know if there was a mass queue ” [School nurse, UK] [69]. There was reluctance to challenge parents who actively refused consent for the HPV vaccine [46,61,69]: “ I would feel very uncomfortable about that because what we are trying to do is build up a relationship with parents here.…”

“…They would have to make some sort of later appointment to speak to the young person and have a serious chat which in itself would then single them out from , you know if there was a mass queue ” [School nurse, UK] [69]. There was reluctance to challenge parents who actively refused consent for the HPV vaccine [46,61,69]: “ I would feel very uncomfortable about that because what we are trying to do is build up a relationship with parents here. I am asking parents to support the college in terms of rules , regulations , etc ., and here I am then saying to parents , ‘ Well in this case tough , what you say really does not count .’ It puts us in a very awkward position ” [Head teacher, UK] [69].…”

“…One school nurse justified her willingness to vaccinate in the face of parental refusal on the grounds of a clear health benefit: “ If I know this particular twelve year old girl is a risk of contracting an illness for which there is an injection that will prevent this illness then it is most definitely in her interest to give it to her , even if her parents don ’ t agree ” [School nurse, UK] [69]. Primary care professionals also acknowledged the difficulty of vaccinating without parental consent: “ Actually she ’ s being very responsible in coming , we want to encourage that.…”