Many US physicians communicate with parents in ways that may discourage HPV vaccination

Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Melissa B. Gilkey, PhD, assistant professor of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston.

Gilkey noted that although HPV vaccination is an effective, safe, and easy way to prevent certain cancers and other conditions, very few U.S. adolescents get vaccinated in a timely manner. Prior research has shown that a health care provider's recommendation is the single biggest influence on whether parents decide to get the HPV vaccine for their adolescents. Given their influence, understanding how providers communicate about HPV vaccination is critical for getting more adolescents vaccinated, she explained.

Gilkey and colleagues, including Noel Brewer, PhD, the study's senior author and an associate professor of health behavior at the University of North Carolina, conducted a national online survey of U.S. pediatricians and family physicians in 2014, in which they measured five indicators of HPV vaccine recommendation quality. These indicators included two for timeliness (recommend vaccination by ages 11 to 12 versus older or not at all, for girls and for boys), and one each for consistency (recommend for all versus to those considered to be at risk), urgency (recommend same-day vaccination versus otherwise), and strength of endorsement (saying that the vaccine is "very" or "extremely" important versus less so).

The study included 776 physicians; 68 percent were male, and 55 percent had 20 or more years of experience in practice.

Gilkey and colleagues found that 27 percent of physicians across the country reported that they do not strongly endorse HPV vaccination, and 26 percent and 39 percent reported that they do not provide timely recommendations for vaccinating girls and boys, respectively. About 59 percent of the physicians recommended HPV vaccination more often for adolescents who they perceived to be at higher risk for getting an HPV infection, as opposed to recommending it routinely for all adolescents. Only 51 percent of physicians recommended same-day vaccination at the time of visit.

The researchers found that the quality of recommendation was higher among physicians who began discussion by saying the child is due for vaccination rather than giving parents information about vaccination or asking them if they had questions about vaccination. Recommendation quality was lower among physicians who were uncomfortable with discussing sexually transmitted infections or who believed that parents thought HPV vaccination was not important.

In an interview, Gilkey said, "The main purpose of our study was to assess how physicians recommend HPV vaccination. Specifically, we wanted to know how often pediatricians and family physicians use five communication practices that are necessary for delivering the vaccine according to national guidelines.

"We were surprised that physicians so often reported recommending HPV vaccination inconsistently, behind schedule, or without urgency. Of the five communication practices we assessed, about half of physicians reported two or more practices that likely discourage timely HPV vaccination," Gilkey said. "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.

"Physicians have a lot of influence on whether adolescents receive the HPV vaccine. Our findings suggest that physicians can improve their recommendations in three ways: by recommending HPV vaccination for all 11- to 12-year-olds and not just those who appear to be at risk; by saying the HPV vaccine is very important; and by suggesting vaccination on the day of the visit rather than at a later date," Gilkey said.

Some of the limitations of the study include the self-reported nature of the measures assessed, possible overestimation by physicians about the quality of their recommendations, and lack of information on recommendation from other vaccine providers such as nurse practitioners and pharmacists, study authors noted.