Stretch Rebecca, McCann Rosemary, Roberts Stephen A, Elton Peter, Baxter David, Brabin Loretta
Academic Unit of Obstetrics and Gynaecology, University of Manchester, St. Mary's Hospital Research Floor (5th), Oxford Road, Manchester M139WL, UK.
BMC Public Health. 2009 Jul 21;9:254. doi: 10.1186/1471-2458-9-254.
In the UK, parental consent for the routine vaccination of 12-13 year olds schoolgirls against human papillomavirus (HPV) is recommended, although legally girls may be able to consent themselves. As part of a vaccine study conducted ahead of the National HPV Vaccine Programme we sought the views of school nurses on vaccinating girls who did not have parental consent.
HPV vaccination was offered to all 12 year old girls attending schools in two Primary Care Trusts in Greater Manchester. At the end of the study semi-structured, tape-recorded interviews were conducted with school nurses who had delivered the vaccine (Cervarix). The interview template was based on concepts derived from the Theory of Planned Behaviour. Transcripts were analysed thematically in order to understand school nurses' intentions to implement vaccination based on an assessment of Gillick competency.
School nurses knew how to assess the competency of under-16s but were still unwilling to vaccinate if parents had refused permission. If parents had not returned the consent form, school nurses were willing to contact parents, and also to negotiate with parents who had refused consent. They seemed unaware that parental involvement required the child's consent to avoid breaking confidentiality. Nurses' attitudes were influenced by the young appearance and age of the school year group rather than an individual's level of maturity. They were also confused about the legal guidelines governing consent. School nurses acknowledged the child's right to vaccination and strongly supported prevention of HPV infection but ultimately believed that it was the parents' right to give consent. Most were themselves parents and shared other parents' concerns about the vaccine's novelty and unknown long-term side effects. Rather than vaccinate without parental consent, school nurses would defer vaccination.
Health providers have a duty of care to girls for whom no parental consent for HPV vaccination has been given, and in the UK, this includes conducting, and acting upon, an assessment of the maturity and competence of an adolescent minor. To facilitate this, policies, training and support structures for health providers should be implemented.
在英国，建议12 - 13岁女学生常规接种人乳头瘤病毒（HPV）疫苗需获得家长同意，不过从法律上讲女孩自身也可以同意接种。作为在国家HPV疫苗计划之前开展的一项疫苗研究的一部分，我们征求了学校护士对于为未获得家长同意的女孩接种疫苗的看法。
向大曼彻斯特地区两个初级保健信托基金辖区内所有12岁的在校女生提供HPV疫苗接种服务。在研究结束时，对已提供疫苗（卉妍康）的学校护士进行了半结构化的录音访谈。访谈模板基于从计划行为理论衍生出的概念。对访谈记录进行了主题分析，以便根据吉利克能力评估来了解学校护士实施疫苗接种的意图。
学校护士知道如何评估16岁以下青少年的能力，但如果家长拒绝许可，他们仍不愿意接种。如果家长未返还同意书，学校护士愿意联系家长，也愿意与拒绝同意的家长进行协商。他们似乎没有意识到家长参与需要孩子的同意以避免违反保密规定。护士的态度受学年组学生年轻的外表和年龄影响，而非个人的成熟程度。他们对关于同意的法律准则也感到困惑。学校护士承认孩子有接种疫苗的权利，并强烈支持预防HPV感染，但最终认为给予同意是家长的权利。大多数护士自己也是家长，也和其他家长一样担心疫苗的新颖性和未知的长期副作用。学校护士不会在未经家长同意的情况下接种疫苗，而是会推迟接种。
对于未获得家长同意接种HPV疫苗的女孩，医疗服务提供者有照护责任，在英国，这包括对青少年未成年人的成熟度和能力进行评估并据此采取行动。为便于开展此项工作，应为医疗服务提供者实施相关政策、培训和支持架构。
