Numerous studies demonstrate that medical professionals often fail to communicate effectively about the of human papillomavirus (HPV) vaccine with patients and parents. Interventions to improve adolescent HPV vaccine uptake by other means are a national priority.
The incidence of human papillomavirus (HPV)–related cancers is more than 35,000 cases each year in the United States. Conversely, evidence indicates that effective HPV vaccines are underused among adolescents, the target population for vaccination. In order to combat this disparity, interventions to increase uptake are needed. For a study published in JAMA Pediatrics, Amanda F. Dempsey, MD, PhD, MPH, and colleagues sought to determine if implementation of an intervention to improve primary care professionals’ HPV vaccine communication lead to increases in adolescent HPV.
“Only about 40% of US adolescents have completed the HPV vaccine series,” says Dr. Dempsey. “This level of utilization is much lower than other vaccines targeted to the same age range, which have use in the range of 85% or greater. Methods for increasing HPV vaccination rates are needed. Numerous studies have shown that a provider recommendation is one of the key factors that influences parents’ decisions about the vaccines. Yet, research also shows that providers often recommend the vaccine in ways that are sub-optimal, such as presenting the vaccine as somehow less important, less urgent, or somehow ‘riskier’ than other vaccines given to adolescents.”
A Novel Toolkit
Dr. Dempsey and colleagues developed a five-component “toolkit” to help providers improve how they communicate about HPV vaccines. The toolkit included communication training (using a presumptive vaccine recommendation for opening the HPV vaccine conversation followed by motivational interviewing techniques if parents seemed hesitant to agree to vaccinate), a parent educational website, a paper decision aid, a customizable HPV vaccine “fact sheet,” and a set of disease images. Practices involved in the study had the freedom to choose which components to implement. The goal was to see how and whether primary care practices would use the toolkit items, and whether their use was related to increases in adolescent HPV vaccination among their patients. Vaccination levels were assessed prior to launching the study and at the end of a 12-month study period. For the randomized controlled trial, eight practices received the toolkit and eight control practices continued “usual care.”
Of the 16 practices and more than 43,000 patients observed, (50.3% female; median age, 12.6 years) adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46) and completion (aOR, 1.56) than those in the control practices (a 9.5–absolute percentage point increase in HPV vaccine series initiation and a 4.4–absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices when compared with family medicine practices and in private practices compared with public. Healthcare professionals at the study locations reported that communication training and the fact sheets were the most used and useful intervention components.
“Providers reported that even though they were using these new communication techniques and tools, their visits, on average, were not any longer than before using the toolkit,” Dr. Dempsey says. “Any intervention that is being considered to be implemented in a clinical setting needs to work within that setting’s limitations in terms of time and clinic flow. Our intervention was successful in doing that, which improves the potential for disseminating it to other clinical settings.”
The study team also ascertained that the intervention seemed effective across all age groups (not just for “catch up” vaccination among those aged 13 to 17, and not just among those aged 11 to 12 who may have been just learning about the HPV vaccine from their physician for the first time), and across both genders. “The intervention was effective primarily among those with private insurance,” Dr. Dempsey adds. “This is likely related to confounding with the type of clinic that these patients tend to visit, which are private practices (as opposed to public clinics).”
Dr. Dempsey says that with minimal effort and training, providers can relatively easily incorporate the most critical elements of the toolkit into their daily practices, thereby significantly improving their adolescent vaccination rates, without sacrificing their clinical efficiency.