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How Physicians Communicate With Parents May Discourage HPV Vaccination of Adolescents

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Key Points

  • A national survey of family physicians assessing the quality of their HPV vaccine recommendations to parents finds that many physicians recommend HPV vaccine inconsistently, behind schedule, or without urgency, which likely contribute to underimmunization among adolescents, and may convey ambivalence to parents.
  • Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine vs giving information or eliciting questions.
  • These findings can inform state and national initiatives that aim to improve communication to address the persistent underuse of the HPV vaccine and provide opportunities to protect adolescents from future HPV-related cancers

A nationwide online survey of 776 pediatricians and family physicians assessing the quality of their human papillomavirus (HPV) vaccine recommendations to parents has found that a sizable minority of physicians—27%—said they do not strongly endorse HPV vaccination, and 26% and 39% reported that they do not provide timely recommendations for vaccinating girls and boys, respectively. The survey also found that recommendation quality was lower among physicians who were uncomfortable talking about the HPV vaccine or who believed that parents did not value the vaccine.

These practices, according to the study, likely contribute to underimmunization among adolescents and may convey ambivalence to parents. Recommendation quality was higher among physicians who began discussions by saying the child was due for HPV vaccine vs giving information or eliciting questions. The study by Gilkey et al is published in Cancer Epidemiology, Biomarkers & Prevention.

Study Methodology

The Physician and Communication About HPV Vaccination Study was an online survey of pediatricians and family physicians in the United States conducted from April to June 2014. The survey was emailed to 2,368 primary care physicians who indicated that they provide preventive care, including vaccinations, to adolescent patients aged 11 to 12 years, the ages specified to receive routine HPV vaccination.

A total of 776 physicians completed the survey. About two-thirds of respondents were male, and over half had 20 or more years of experience in practice. The vast majority of physicians (83%) saw 10 or more adolescent patients per week.

The researchers assessed the quality of the respondents’ HPV vaccine recommendations based on strength of endorsement, such as saying the vaccine is important; timeliness, recommending it by ages 11 to 12; consistency, recommending it routinely vs using a risk-based approach; and urgency, recommending same-day vaccination. Because some physicians characterize the HPV vaccine as an optional vaccine, the researchers also assessed the respondents’ strength of endorsement, or saying that the vaccine is “very” or “extremely” important vs less so.

Study Findings

The researchers found that a sizable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending the HPV vaccine, and only half (51%) usually recommended same-day vaccination.

Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine vs giving information or eliciting questions.

“We were surprised that physicians so often reported recommending HPV vaccination inconsistently, behind schedule, or without urgency,” said Melissa B. Gilkey, PhD, Assistant Professor of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, and lead author of the study, in a statement.

“Of the five communication practices we assessed, about half of physicians reported two or more practices that likely discourage timely HPV vaccination. We are currently missing many opportunities to protect today’s young people from future HPV-related cancers. Helping providers communicate about the HPV vaccine effectively is a promising strategy for getting more adolescents vaccinated.”

Dr. Gilkey is the corresponding author of this study.

Funding for the study was provided by the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center, the National Cancer Institute, and an unrestricted educational grant from Pfizer. Noel T. Brewer, PhD, received HPV vaccine-related grants from or has been on advisory boards for GlaxoSmithKline PLC, Merck, and Pfizer. The other study authors reported no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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