Institute for Work & Health, Toronto, Ontario, Canada.
PLoS One. 2011;6(8):e22737. doi: 10.1371/journal.pone.0022737. Epub 2011 Aug 2.
Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue.
METHODOLOGY/PRINCIPAL FINDINGS: In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤ 16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%), and only 50.5% (48 of 95) reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95) reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81) were less comfortable continuing care as a result. Five percent (4 of 81) of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26) or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44) were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46) of parent's with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision.
CONCLUSIONS/SIGNIFICANCE: Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children.
选择为孩子有选择地接种疫苗或避免接种疫苗的父母可能会冒着与家庭医生或儿科医生关系破裂的风险。与儿科疫苗接种率降低有关的群体，例如接受顺势疗法护理的父母，可能特别容易受到这个问题的影响。
方法/主要发现：2010 年 3 月至 9 月，我们对 129 名成年患者进行了一项 26 项的横断面调查，这些患者均为安大略省加拿大的顺势疗法护理就诊的≤16 岁儿童的父母。95 名父母完成了调查（应答率为 74%），只有 50.5%（48/95）报告他们的孩子接受了所有建议的疫苗。大多数父母（50.5%；48/95）报告说他们受到家庭医生接种疫苗的压力，在与医生讨论疫苗接种的父母中，25.9%（21/81）因此感到不太愿意继续接受治疗。5%（4/81）的受访者被医生告知，如果他们决定不接种疫苗，他们的孩子将被拒绝治疗。在我们调整的广义线性模型中，感到接种疫苗的压力（优势比[OR] = 3.07；95%置信区间[CI] = 1.14 至 8.26）或认可顺势疗法医生是他们接种疫苗的最信任信息来源（OR = 3.57；95%CI = 1.22 至 10.44）与孩子部分接种或未接种疫苗的可能性更大相关。大多数（69.6%；32/46）部分接种或未接种疫苗的儿童的父母表示愿意重新考虑这一决定。
结论/意义：应该在父母中探索顺势疗法的使用，以确定这一高风险群体，并就儿科疫苗接种问题与他们进行讨论，以鼓励基于证据的共同决策。医生应确保接种疫苗的讨论是尊重的，即使父母决定不接种他们的孩子。
