Findings from a survey led by a UNC Lineberger Comprehensive Cancer Center researcher show that a sizeable minority of physicians did not strongly endorse the HPV vaccine or deliver timely recommendations for girls or boys.
The findings were published recently in the journal Cancer Epidemiology, Biomarkers & Prevention.
“A doctor’s recommendation is the main thing that motivates parents to get HPV vaccination for their children,” said the study’s senior author Noel Brewer, PhD, a UNC Lineberger member and associate professor in the UNC Gillings School of Global Public Health. “However, low-quality communication about HPV vaccination is common. Many physicians recommend HPV vaccine hesitantly or late or not at all. “
To study the quality of doctors’ HPV vaccine recommendations, Brewer and a research team that included four other UNC researchers created an online survey about human papillomavirus (HPV) vaccine recommendations. In 2014, a national sample of 776 pediatricians and family physicians completed the survey.
The researchers then assessed the quality of respondents’ vaccine recommendations by evaluating the strength of endorsement (i.e., telling patients/parents the vaccine is important), timeliness (recommending it by ages 11–12), consistency (recommending it routinely versus using a risk-based approach) and urgency (recommending same-day vaccination).
Findings from the survey show that a sizeable minority of physicians, or 27 percent, did not strongly endorse the HPV vaccine or deliver timely recommendations for girls (26 percent) or boys, (39 percent).
Many physicians, or 59 percent, used a risk-based approach to recommending the HPV vaccine, and only half at 51 percent usually recommended same-day vaccination.
Overall, the quality of recommendations was lower among physicians who were uncomfortable talking about the HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by stating that a child was due for the HPV vaccine, instead of giving general information or eliciting questions.
Based on these results, the researchers conclude that many physicians recommend the HPV vaccine inconsistently, behind schedule or without urgency. These practices likely contribute to under-immunization among adolescents, and may convey ambivalence to parents.
“Low uptake of HPV vaccination is contributing to a national crisis in cancer prevention,” Brewer said. “Doctors should urgently and strongly recommend the vaccine for all 11-12 year olds.”
This was one of the first studies to assess multiple aspects of HPV vaccine recommendation quality. The findings should inform future state and national initiatives that aim to improve communication about the HPV vaccine. Improving the quality of physicians’ recommendations for the vaccine, the researchers say, could help to address the persistent underuse of a powerful tool for cancer prevention.
The paper, “Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey,” was published online Oct. 22 in Cancer Epidemiology, Biomarkers & Prevention.
Melissa Gilkey, PhD, is a former postdoctoral fellow with UNC’s Cancer Control Education Program and lead author of the paper. She worked with four researchers from the UNC Gillings School of Global Public Health: Brewer, Parth Shah, doctoral student; Megan Hall, assistant program director; and Teri Malo, PhD, postdoctoral research associate, all with the Gillings School of Global Public Health's Department of Health Behavior.