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Study: Doctor communication may discourage HPV vaccination

A quarter of doctors said they do not strongly endorse the vaccine, and nearly two-thirds only recommend it to adolescents they think are at risk for the STI.
By Stephen Feller   |   Oct. 22, 2015 at 2:37 PM

PHILADELPHIA, Oct. 22 (UPI) -- A study found that a quarter of doctors do not strongly endorse the human papillomavirus, or HPV, vaccine and doctors who do endorse it focus more on patients they believe to be at risk rather than adolescents overall.

The study found that doctors who were uncomfortable discussing sexually transmitted infections or thought a patient's parents were not in favor of the vaccine made far less effective recommendations for it.

The HPV vaccine is recommended for all adolescent boys and girls ages 11 and 12 based on its ability to prevent HPV infection, which can cause cervical and anal cancers, and also genital warts.

A study in Texas found that a more rigorous, information driven outreach program increased the number of children receiving the vaccine, and other recent studies have reinforced the efficacy of the vaccine to prevent cancer and not promote promiscuity among teenagers.

"We were surprised that physicians so often reported recommending HPV vaccination inconsistently, behind schedule, or without urgency," said Dr. Melissa Gilkey, an assistant professor of population medicine at Harvard Medical School, in a press release. "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."

Researchers conducted a national online survey with 776 pediatricians and family doctors, assessing them on quality of strength of vaccine endorsement, timeliness of vaccination, consistency of their recommendations and urgency for patients to be vaccinated.

More than a quarter of physicians, 27 percent, do not strongly endorse the vaccine. While more doctors offer timely recommendations of the vaccine for girls than boys, 26 percent of doctors are not timely with girls and 39 percent are not timely with boys.

Overall, 59 percent of doctors reported they recommend the vaccine based on their own assessment of risk for contracting HPV and only 51 percent suggest the vaccine be given during the office visit in which it was recommended.

Doctors with more success in vaccinating patients said they open the conversation by saying the child is due for the vaccine, as opposed to simply providing information or asking patients and parents what they thought about it.

The study's results echo one conducted using a trial outreach program in Texas at safety net clinics with lower income patients. The trial found providing information to patients on the vaccine, including later conversations with parents who were apprehensive and follow-up calls to patients for the second and third shots of the three-shot vaccine helped improve vaccination rates.

"Physicians have a lot of influence on whether adolescents receive the HPV vaccine," Gilkey said. "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."

The study is published in Cancer Epidemiology, Biomarkers, and Prevention.

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