436 - Dismissal Policies for Vaccine Refusal Among US Pediatricians: A Qualitative Study

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 436
Publication Number: 436.323

Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Elizabeth R. Kerr, Duke University School of Medicine, Durham, NC, United States; Sarah E. Brewer, University of Colorado School of Medicine, Aurora, CO, United States

Presenting Author(s)

Sean T. O'Leary, MD, MPH (he/him/his)

Professor of Pediatrics
University of Colorado School of Medicine
Denver, Colorado, United States

Background: In 2016, the American Academy of Pediatrics (AAP) amended its official policy on the practice of dismissing families who refuse vaccines from a stance that it is not an acceptable practice to state that, in certain circumstances, “…the individual pediatrician may consider dismissal of families who refuse vaccination as an acceptable option.” A recent national survey suggests an increase in the number of pediatricians who have a personal or office-wide vaccine dismissal policy. However, little is known about how or why these policies are implemented.

Objective: To describe, among pediatricians who do and do not have dismissal policies, decision-making behind and experiences with policies regarding families who refuse vaccination.

Design/Methods: Semi-structured qualitative interviews among US primary care pediatricians. Pediatricians were recruited through a national AAP listserv and a Colorado-based practice-based research network. Interviews were conducted via Zoom or phone based on pediatrician preference. Recruitment continued until thematic saturation was reached. Semi-structured interviews guides were developed for each group. Interviews were recorded and transcribed. Transcripts were organized and reviewed using a matrix analysis approach. Emergent ideas were summarized and themes identified and synthesized through iterative memoing and consensus building.

Results:

17 interviews with pediatricians were performed from 9/2020 to 6/2021, with representation from all 4 US Census Regions. 10 were “dismissers” and 7 were “non-dismissers.” All dismissal policies were reported as practice-wide (as opposed to personal practice). We identified 4 themes, 2 with subthemes (Table):

(1) Dismissers and non-dismissers felt justified in their current policy.

a. They want to provide quality care

b. Strong ethic of caring for and serving all children

c. Dismissal policies vary

d. Experience frustration with vaccine refusal

(2) Providers report that parents self-select practices that fit their vaccination intentions

(3) Different types of vaccine refusers

a. Refusers vary

b. Parents’ concerns vary

(4) Pediatricians with and without dismissal policies felt supported by AAP Policy.

Conclusion(s):

Pediatricians with and without dismissal policies endorse ethical considerations and AAP guidance in support of their current policies. Parents seek out practices specifically because of dismissal policies. Future research should explore the impact such policies have on vaccination rates, parent-provider trust, and access to a medical home.