A semi-qualitative study of attitudes to vaccinating adolescents against human papillomavirus without parental consent.
(57/200)BACKGROUND: The first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10-14 year old girls. HPV is a sexually transmitted virus and some parents may refuse consent for vaccination. Under-16s in the UK have a right to confidential sexual health care without parental consent. We investigated parents' views on making available HPV vaccination to adolescent minors at sexual health clinics without parental consent. METHODS: This was a semi-qualitative analysis of views of parents of 11-12 year old school children collected as part of a population-based survey of parental attitudes to HPV vaccination in Manchester. Parents were firstly asked if they agreed that a well-informed child should be able to request vaccination at a sexual health clinic without parental consent, and secondly, to provide a reason for this answer. Ethical perspectives on adolescent autonomy provided the framework for descriptive analysis. RESULTS: 307 parents answered the question, and of these, 244 (80%) explained their views. Parents with views consistent with support for adolescent autonomy (n = 99) wanted to encourage responsible behaviour, protect children from ill-informed or bigoted parents, and respected confidentiality and individual rights. In contrast, 97 parents insisted on being involved in decision-making. They emphasised adult responsibility for a child's health and guidance, erosion of parental rights, and respect for cultural and moral values. Other parents (n = 48) wanted clearer legal definitions governing parental rights and responsibilities or hoped for joint decision-making. Parents resistant to adolescent autonomy would be less likely to consent to future HPV vaccination, (67%) than parents supporting this principle (89%; p < 0.001). CONCLUSION: In the UK, the principle of adolescent autonomy is recognised and logically should include the right to HPV vaccination, but this may concern parents who would otherwise approve vaccination. (+info)
Clinicians' knowledge of informed consent.
(58/200)OBJECTIVE: To audit doctors' knowledge of informed consent. DESIGN: 10 consent scenarios with "true", "false", or "don't know" answers were completed by doctors who care for children at a large district general hospital. These questions tested clinicians' knowledge of who could give consent in different clinical situations. SETTING: Royal United Hospital, Bath, UK. RESULTS: 51 doctors participated (25 paediatricians and 26 other clinicians). Paediatricians scored higher than other clinicians (average correct response 69% v 49%). Only 36% (9/25) of paediatricians and 8% (2/26) of other clinicians realised that the biological father of a child born before 1 December 2003 needed a court order or a parental responsibility agreement to acquire parental responsibility, and thus be able to consent on behalf of his child, if he was not married to the child's mother. Non-paediatric clinicians were unsure or incorrect when tested on situations where people with parental responsibility do not agree, or where young people (<16 years), who are Fraser competent do not want to consult their parents. Most clinicians did not know that the parents of a 20-year-old man with severe learning difficulties are unable to consent to surgery on his behalf, and many non-paediatricians were unclear on who could give consent when a child lived with foster parents. CONCLUSION: Clinicians who obtain consent for the treatment of children need to increase their knowledge on who is able to give informed consent to ensure best (legal and safe) practice. (+info)
Children and adolescents - who can give consent?
(59/200)Case histories are based on actual medical negligence claims or medicolegal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. Can children and adolescents consent to their own medical treatment? Do general practitioners owe teenagers a duty of confidentiality? This article examines the legal obligations of GPs when obtaining consent to medical treatment from patients who are under 18 years of age. (+info)
Improving informed consent: suggestions from parents of children with leukemia.
(60/200)OBJECTIVE: The objective of this study was to report suggestions for improving the informed consent process from the perspective of parents of children with leukemia. METHODS: Recommendations for improving informed consent were elicited from 140 parents of children who had been offered participation in a randomized clinical trial for the treatment of their acute leukemia. Four different methods and data collection time points were used with this group of parents, including open-ended, in-person interviews within 72 hours after the informed consent conference; follow-up telephone interviews 6 months after diagnosis; focus groups during year 3 of the project; and a parent advisory group on informed consent meeting in year 4. RESULTS: The most frequently cited suggestions for improving informed consent during the interviews and focus groups related to giving parents more time to make their decision, the amount and type of information provided, organization of the consent conference, communication style, and providing additional materials. During the parent advisory group on informed consent meeting, parents developed specific guidelines for organization of the information that is presented during the consent process that include 7 major components: timing, sequence, checklist, checking for understanding, anticipatory guidance, segue into randomized clinical trial discussion with historical perspective, and choice. CONCLUSIONS: Through the incorporation of parental perspectives that provide an authentic stakeholder voice, our research represents a true partnership approach to improving the consent process. Parents provided practical advice for improving informed consent that can be applied to most adult and pediatric patient populations. (+info)
Enrolling adolescents in HIV vaccine trials: reflections on legal complexities from South Africa.
(61/200)BACKGROUND: South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality. DISCUSSION: This article sets out essential requirements for the lawful conduct of adolescent research in South Africa including compliance with consent requirements, child protection laws, and processes for the ethical and regulatory approval of research. SUMMARY: This article outlines likely complexities for researchers and research ethics committees, including determining that trial interventions meet current risk standards for child research. Explicit recommendations are made for role-players in other jurisdictions who may also be planning such trials. This article concludes with concrete steps for implementing these important trials in South Africa and other jurisdictions, including planning for consent processes; delineating privacy rights; compiling information necessary for ethics committees to assess risks to child participants; training trial site staff to recognize when disclosures trig mandatory reporting response; networking among relevant ethics committees; and lobbying the National Regulatory Authority for guidance. (+info)
Is depressed mood in childhood associated with an increased risk for initiation of alcohol use during early adolescence?
(62/200)OBJECTIVE: Using prospective data, we tested the hypothesis that early depressed mood was associated with an increased risk for initiation of alcohol use. In addition, we examined whether these associations varied according to the youths' report that alcohol consumption occurred with or without parental permission. METHODS: The participants for these analyses were students, ages 9 to 13 years old, participating in a longitudinal study in an urban sample of public schools (n=2311). As part of the prospective annual assessments of the students, in 1990 through 1994, data on depressive mood and alcohol use were gathered. Logistic regression models were used to assess the association between the level of baseline depressed mood in 1990 and initiation of alcohol use between 1991 through 1994 in the sample of youth at risk for new onset drinking (n=1526). Other characteristics assessed in the analyses included age, sex, race-ethnicity, alcohol use by peers, neighborhood environment, and receipt of subsidized lunch. RESULTS: Higher level of early depressed mood was associated with an earlier and increased estimated risk of initiating alcohol use without parental permission for boys but not for girls. Depressed mood was not associated with alcohol use initiation that occurred with parental sanctions. CONCLUSIONS: Findings from the current study support the hypothesis that among urban youth, early depressed mood influences the initiation of alcohol consumption without parental permission for boys. (+info)
Mass distribution of free, intranasally administered influenza vaccine in a public school system.
(63/200)OBJECTIVE: School-based influenza vaccination programs are a potentially important method of protecting the community against influenza. We evaluated the feasibility and success of a large, school-based influenza vaccination campaign. METHODS: On-site administration of intranasally administered, live attenuated influenza vaccine was offered to all students and staff members in a large, metropolitan public school system in October to December 2005. We evaluated vaccine coverage levels, resources expended, and physician and parent attitudes and knowledge. RESULTS: Of 53,420 public school students, 24,198 were vaccinated with live attenuated influenza vaccine. Of 5841 school staff members, 3626 were vaccinated with live attenuated influenza vaccine or inactivated influenza vaccine. The proportions of students vaccinated were 56% among elementary schools, 45% among middle schools, and 30% among high schools. Schools with larger proportions of black or low-income families had lower vaccine coverage levels. The health department and school system expended 6900 person-hours during the campaign, and various health department clinics were closed for a total of 84 half-days. Community physicians were supportive of the campaign and frequently advised participation for eligible patients. Some physicians had misunderstandings about live attenuated influenza vaccine contraindications. Concern about adverse effects, having asthma, negative physician advice, and nonparticipation in any vaccination program were common reasons for students not participating. CONCLUSIONS: This influenza vaccination campaign in a large public school system achieved relatively high vaccine coverage levels but required a substantial resource commitment from the local health department. This evaluation has critical implications for the ongoing debate regarding immunization policies for school-aged children and preparedness plans for pandemic influenza. (+info)
Addressing parents' concerns about childhood immunizations: a tutorial for primary care providers.
(64/200)BACKGROUND: Despite the dangers of vaccine-preventable infections and efforts by health care professionals to promote immunization, parents' resistance to routine childhood immunizations continues to grow. This phenomenon can give rise to frustration among health care providers, as well as create barriers in providing medical care to children in need. In response, we developed a CD-ROM-based tutorial that (1) explains the nature and origins of parents' concerns, (2) addresses clinical implications of resistance to immunization, (3) explores ethical and professional obligations that physicians have toward children and their parents, and (4) discusses how physicians can effectively address parents' concerns. OBJECTIVE: Our goals were to evaluate the tutorial's effectiveness in improving physicians' (1) general knowledge about parents' resistance to childhood immunizations, (2) knowledge of adverse effects of immunization, and (3) attitudes toward parents' resistance to childhood immunization. DESIGN/METHODS: After pretesting, expert review, and revision, the 45-minute Penn State Immunization Project tutorial was pilot tested with pediatric and family medicine residents at 7 training programs in 4 states (Pennsylvania, New York, Maryland, and Iowa). Knowledge and attitudes were assessed by using a 26-item pretest/posttest, the results of which were then analyzed by using standard statistical methods. RESULTS: A total of 122 residents completed the pretest/posttest. Statistically and clinically significant improvements were seen in residents' general knowledge, knowledge of adverse events, and all 5 attitudinal measures regarding childhood immunizations. CONCLUSIONS: The tutorial Addressing Parents Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers is effective in improving resident physicians' general knowledge, knowledge of adverse events, and attitudes. As such, this tutorial has the potential to enhance communication between parents and primary care providers and, more generally, improve clinicians' response to the growing resistance toward routine childhood immunizations. (+info)