Sussman Andrew L, Helitzer Deborah, Sanders Margaret, Urquieta Brisa, Salvador Melina, Ndiaye Khadidiatou
Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Ann Fam Med. 2007 Jul-Aug;5(4):298-304. doi: 10.1370/afm.723.
Primary care clinicians will continue to play an important role in cervical cancer prevention, particularly with regard to administration of the newly licensed human papillomavirus (HPV) vaccine and continued administration of Papanicolaou tests. Little is known about the factors that influence cervical cancer prevention counseling, particularly in the adolescent encounter. We conducted a qualitative study to better understand the implications for counseling about cervical cancer prevention by primary care clinicians who care for adolescents.
We conducted in-depth interviews with 37 primary care clinicians in New Mexico to understand the context in which they provide anticipatory guidance about sexual health risks as well as their attitudes about counseling for the forthcoming HPV vaccine.
Clinicians identified 4 categories of factors related to their counseling experiences with adolescents about HPV: (1) the need to build rapport with adolescent patients, (2) the presumption that adolescent patients engage in high-risk behaviors, (3) the situational delivery and complexity of HPV counseling, and (4) perceptions of clinician and community receptivity to the HPV vaccine.
Our findings show that conditions of the preadolescent and young adolescent visit pose a challenge to the successful integration of counseling about cervical cancer prevention in primary care. Counseling strategies that are designed to emphasize a preventive focus while including parents in the discussion at the time of vaccination and that are appropriate to populations with different cultural values and beliefs will help to enhance communication about cervical cancer prevention and the particular role of the HPV vaccine.
基层医疗临床医生在宫颈癌预防中仍将发挥重要作用，尤其是在新获批的人乳头瘤病毒（HPV）疫苗接种以及持续进行巴氏试验方面。对于影响宫颈癌预防咨询的因素，我们了解甚少，尤其是在青少年诊疗过程中。我们开展了一项定性研究，以更好地理解为青少年提供医疗服务的基层医疗临床医生在宫颈癌预防咨询方面的影响因素。
我们对新墨西哥州的37名基层医疗临床医生进行了深入访谈，以了解他们提供性健康风险预期指导的背景以及他们对即将推出的HPV疫苗咨询的态度。
临床医生确定了与他们为青少年提供HPV咨询经历相关的4类因素：（1）与青少年患者建立融洽关系的必要性；（2）认为青少年患者会从事高风险行为的假设；（3）HPV咨询的情境性传递和复杂性；（4）临床医生和社区对HPV疫苗的接受程度认知。
我们的研究结果表明，青春期前和青少年早期就诊的情况对在基层医疗中成功整合宫颈癌预防咨询构成挑战。旨在强调预防重点、在疫苗接种时让家长参与讨论且适合具有不同文化价值观和信仰人群的咨询策略，将有助于加强关于宫颈癌预防及HPV疫苗特殊作用的沟通。
