Patient—Provider Communication and Human Papillomavirus Vaccine Acceptance

Abstract

The authors performed telephone interviews of parents of adolescents (n = 430) and their older adolescents (n = 208) in Monroe County, New York to measure parent and adolescent acceptance of human papillomavirus (HPV) vaccine, its association with ratings of provider communication, and vaccine-related topics discussed with the adolescent's provider. More than half of adolescent girls had already received an HPV vaccination, with fewer than one quarter refusing. Parent and teen ratings of provider communication was high, and not related to HPV vaccine refusal. Parents were more likely to refuse if they were Hispanic (odds ratio [OR] = 5.88, P = .05) or did not consider vaccines "very safe" (OR = 2.76, P = .04). Most parents of boys (85%) believed males should be given HPV vaccine if recommended. Few parents and teens recalled discussing that vaccination does not preclude future Pap smear testing. Providers should address cultural and vaccine safety concerns in discussions about HPV vaccine.

Provider communication about HPV vaccination: A systematic review

“…18,27,71,73,76,80 In addition to age, patients' sex added complexity to communication, with providers offering different prevention messages to boys and girls. 17,22,27,29,35,38,40,76,81 Second, at the interpersonal level, many providers perceived parents as being unsupportive of HPV vaccination, a view which hindered guideline-consistent delivery of recommendations. 12,29,33,35,[37][38][39] Third, studies consistently documented a challenging policy context, including unclear practice guidelines and a lack of school entry requirements for HPV vaccination.…”

“…80 Studies suggested that parent-adolescent decisions were largely concordant and that most dyads ultimately reached agreement about the vaccination decision, but they sometimes looked to providers for guidance in the case of initial disagreement. 76,81 Interestingly, one qualitative study noted that adolescents' participation in medical dialog was often subtle and included non-verbal forms of communication such as nods, suggesting that adolescents' communication role could be easy to overlook. 76 …”

“…Almost all providers reported mentioning cancer prevention when they discussed HPV vaccination. 33,59 However, studies of girls suggested that providers placed a higher priority on cancer prevention 17,29,35,38,40,81 than studies of boys. 22,27,29,40,76 For girls, discussions centered on cervical cancer prevention, and included genital warts and STIs less often.…”

“…22,27,29,40,76 For girls, discussions centered on cervical cancer prevention, and included genital warts and STIs less often. 35,38,40,79,81 For boys, prevention topics were more varied with the prevention of genital warts and STIs featuring as or more prominently than the prevention of cancer; 22,27,29,76 cancer topics included cervical cancer prevention for future partners and, less frequently, the prevention of male cancers in patients themselves. 22,27,29,40,76 Several qualitative studies found that some providers chose to discuss cancer, but not genital warts or STIs, so as to avoid talking about sex; 27,59 however, a quantitative study found that, for boys, very few providers discussed one without the other.…”

“…18,21,38 In contrast to these preferences, several studies indicated deficiencies in provider communication about how to complete the 3 dose series. 27,76,81,85 Fewer studies assessed actual content in terms of the availability of HPV vaccine for boys, cost, and timing. 22,76 Style Studies of communication style focused on four areas: 1) recommendation strength; 2) recommendation quality; 3) the framing of HPV vaccine in relation to other adolescent vaccines; and 4) collaborative communication.…”