Providers encounter and agree to parental vaccine spacing requests

1. In response to a survey, many pediatricians endorsed feeling as though parents place their children at increased risk for vaccine-preventable diseases by staggering vaccine schedules, but honor these requests in a reported attempt to build trust with families.

2. Providers used various strategies to negotiate the discrepancy between their knowledge and the wishes of the families, though most did not report these strategies effective. Many pediatricians endorsed decreased job satisfaction in the context of this discrepancy.

Evidence Rating Level: 2 (Good)

Study Rundown: The proportion of families using an alternative vaccination schedule for their children has been increasing in recent years, leading to undervaccination and resurgence of vaccine-preventable illnesses. This study explores physicians’ attitudes and actions surrounding parental requests for modified vaccine schedules. In response to an internet and mail survey, most physician participants reported encountering some parents asking for alternative childhood vaccine schedules. Most physicians reported their belief that this practice puts children at increased risk for contracting preventable diseases. A vast majority believed that agreeing to an alternative schedule built trust and prevented families from leaving their practice. Three-quarters of physicians comply with these requests at least sometimes, while some reported decreased job satisfaction as a result of these discussions. Providers used various methods to address parents’ requests, such as discussing recent outbreaks of diseases or explaining that alternative schedules are not well-studied. The vast majority believed these strategies were not very/not at all effective. Although this study is limited by the subjective nature of the responses, it highlights the need for more proven guidance on how to effectively address vaccine schedules with parents, while still allowing time to provide anticipatory guidance on other topics.

Click to read the study published in Pediatrics

Relevant Reading: Association between undervaccination with diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine and risk of pertussis infection in children 3 to 36 months of age

In-Depth [survey]: This study recruited a nationally representative sample of pediatricians and family practitioners from the American Academy of Pediatrics (AAP) and the American Academy of Family Practitioners (AAFP) directories and administered an email and mail-based survey created in conjunction with the Centers for Disease Control and Prevention, the AAP, and the AAFP. The overall survey response rate was 66%, with 93% of responders stating that at least some parents of children <2 years old asked about using an alternative vaccination schedule for their child every month. Eighty-seven percent of providers believed that spreading out these vaccines put children at increased risk of infection with these diseases and 84% believed that this practice was more painful for children. Eighty-two percent of providers endorsed that agreeing with parental requests would help build trust with the family while 80% believed if they did not comply, the family would leave their practice. Seventy-four percent of responders sometimes or often complied with these requests and 40% reported decreased job satisfaction as a result of these requests. Providers employed many strategies when discussing alternative schedules, though up to 96% felt that certain strategies were not very or not at all effective in convincing families to use the recommended schedule.

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