In the Journals

Physicians inconsistently provide strongest HPV vaccine recommendation

Allison Kempe 2019
Allison Kempe

Although pediatricians and family physicians often recommend HPV vaccination, recent survey data suggest that these providers do not always use the strongest recommendation and do not always recommend the vaccine for younger adolescents.

“Our data show that many providers are not introducing the HPV vaccine in the same way as they do the other adolescent vaccines — TdaP and meningococcal conjugate vaccine — that are also recommended at ages 11 to 12 years,” Allison Kempe, MD, MPH, director of the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado Anschutz Medical Center and Children's Hospital Colorado, told Infectious Diseases in Children. “A ‘presumptive’ recommendation means you introduce all the vaccines in the same way with the assumption that there won’t be resistance to them. This results in higher rates of vaccine acceptance by parents.”

The CDC currently recommends that the HPV series can begin at age 9 years, but routine vaccination is recommended at ages 11 or 12 years.

Kempe and colleagues surveyed pediatricians and family physicians online and by mail between July 2018 and September 2018. Of the providers who responded, 302 were pediatricians and 228 were family physicians (65% response rate).

Pediatricians most often gave strong recommendations to female patients aged 15 years and older (99%) and least often to male patients aged 11 to 12 (83%). Family physicians gave strong recommendations less often than pediatricians, with 90% giving strong recommendations to female patients aged 15 years and older and 66% giving strong recommendations for male patients aged 11 to 12 years.

Pediatricians were more likely to always or almost always use a “presumptive” style when discussing HPV vaccination compared with family physicians (65% vs. 42%; P < .0001). Nearly one-quarter of family physicians and 16% of pediatricians always or almost always used conversational discussion style.

Further analysis revealed that providers who did not use a strong recommendation to patients aged 11 to 12 years did not use a presumptive style of discussion, perceived less resistance at HPV vaccine introduction in patients aged 13 years compared with younger patients and, predicting that the conversation would be uncomfortable, found the discussion resulted in parent and patient refusal or deferral.

Most pediatricians (89%) and family physicians (79%) noted that more teenagers aged younger than 15 years were completing the HPV series after the two-dose recommendation was made, the researchers wrote.

“One of the reasons for this publication is to make more physicians aware of past literature showing that early HPV vaccination is important, that physicians frequently overestimate the amount of parental resistance they will encounter if they strongly recommend, and the effectiveness of a strong presumptive recommendation by physicians,” Kempe said.

“Our data underline the areas where providers need to improve in order to accomplish higher rates of early HPV vaccination. Other important sources of information and education for physicians that should help with encouraging these behaviors are the national practice organizations that physicians look to, especially the American Academy of Pediatrics and the American Academy of Family Physicians.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Allison Kempe 2019
Allison Kempe

Although pediatricians and family physicians often recommend HPV vaccination, recent survey data suggest that these providers do not always use the strongest recommendation and do not always recommend the vaccine for younger adolescents.

“Our data show that many providers are not introducing the HPV vaccine in the same way as they do the other adolescent vaccines — TdaP and meningococcal conjugate vaccine — that are also recommended at ages 11 to 12 years,” Allison Kempe, MD, MPH, director of the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado Anschutz Medical Center and Children's Hospital Colorado, told Infectious Diseases in Children. “A ‘presumptive’ recommendation means you introduce all the vaccines in the same way with the assumption that there won’t be resistance to them. This results in higher rates of vaccine acceptance by parents.”

The CDC currently recommends that the HPV series can begin at age 9 years, but routine vaccination is recommended at ages 11 or 12 years.

Kempe and colleagues surveyed pediatricians and family physicians online and by mail between July 2018 and September 2018. Of the providers who responded, 302 were pediatricians and 228 were family physicians (65% response rate).

Pediatricians most often gave strong recommendations to female patients aged 15 years and older (99%) and least often to male patients aged 11 to 12 (83%). Family physicians gave strong recommendations less often than pediatricians, with 90% giving strong recommendations to female patients aged 15 years and older and 66% giving strong recommendations for male patients aged 11 to 12 years.

Pediatricians were more likely to always or almost always use a “presumptive” style when discussing HPV vaccination compared with family physicians (65% vs. 42%; P < .0001). Nearly one-quarter of family physicians and 16% of pediatricians always or almost always used conversational discussion style.

Further analysis revealed that providers who did not use a strong recommendation to patients aged 11 to 12 years did not use a presumptive style of discussion, perceived less resistance at HPV vaccine introduction in patients aged 13 years compared with younger patients and, predicting that the conversation would be uncomfortable, found the discussion resulted in parent and patient refusal or deferral.

Most pediatricians (89%) and family physicians (79%) noted that more teenagers aged younger than 15 years were completing the HPV series after the two-dose recommendation was made, the researchers wrote.

“One of the reasons for this publication is to make more physicians aware of past literature showing that early HPV vaccination is important, that physicians frequently overestimate the amount of parental resistance they will encounter if they strongly recommend, and the effectiveness of a strong presumptive recommendation by physicians,” Kempe said.

“Our data underline the areas where providers need to improve in order to accomplish higher rates of early HPV vaccination. Other important sources of information and education for physicians that should help with encouraging these behaviors are the national practice organizations that physicians look to, especially the American Academy of Pediatrics and the American Academy of Family Physicians.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.