Family communication surrounding HPV vaccination can support or hinder HPV cancer prevention strategies. We used narrative communication theory to elicit HPV vaccine decision narratives in the context of family communication from a purposive sample of 29 parents of adolescents. Parent narratives indicated that family negotiations occur throughout the decision-making process, topic avoidance was common among parents of unvaccinated and undervaccinated children, parents had concerns that vaccination is a sign of approving sexual permissiveness, and family communication was often prompted by encounters in the exam room. Understanding complex family dynamics in the context of vaccination decision-making, the role of family communication (or lack thereof) in decisions, and effective negotiation and communication strategies can inform messaging tactics aimed at addressing disagreements in families and indicate how vaccinating may align rather than conflict with family values.