Gilkey Melissa B, Malo Teri L, Shah Parth D, Hall Megan E, Brewer Noel T
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2015 Nov;24(11):1673-9. doi: 10.1158/1055-9965.EPI-15-0326. Epub 2015 Oct 22.
Improving the quality of physicians' recommendations for human papillomavirus (HPV) vaccination is critical to addressing low coverage. Thus, we sought to describe HPV vaccine communication practices among primary care physicians.
Pediatricians and family physicians (n = 776) completed our national online survey in 2014. We assessed the quality of their HPV vaccine recommendations on strength of endorsement (i.e., saying the vaccine is important), timeliness (recommending it by ages 11-12), consistency (recommending it routinely vs. using a risk-based approach), and urgency (recommending same-day vaccination).
A sizeable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending HPV vaccine, and only half (51%) usually recommended same-day vaccination. Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine versus giving information or eliciting questions.
Many physicians in our national sample reported recommending HPV vaccine inconsistently, behind schedule, or without urgency. These practices likely contribute to under-immunization among adolescents, and may convey ambivalence to parents.
As one of the first studies to assess multiple aspects of recommendation quality, these findings can inform the many state and national initiatives that aim to improve communication about HPV vaccine so as to address the persistent underuse of a powerful tool for cancer prevention.
提高医生对人乳头瘤病毒(HPV)疫苗接种建议的质量对于解决接种率低的问题至关重要。因此,我们试图描述初级保健医生中HPV疫苗的沟通实践情况。
儿科医生和家庭医生(n = 776)于2014年完成了我们的全国在线调查。我们从支持力度(即表示疫苗很重要)、及时性(在11 - 12岁时推荐)、一致性(常规推荐与基于风险的方法)和紧迫性(推荐当日接种)方面评估了他们HPV疫苗建议的质量。
相当一部分医生报告称,他们没有强烈支持HPV疫苗(27%),或者没有及时为女孩(26%)或男孩(39%)提供建议。许多医生(59%)采用基于风险的方法来推荐HPV疫苗,只有一半(51%)的医生通常推荐当日接种。在那些对谈论HPV疫苗感到不舒服或者认为家长不重视的医生中,总体建议质量较低。与提供信息或引发问题相比,那些以孩子该接种HPV疫苗为由开始讨论的医生,其建议质量更高。
在我们的全国样本中,许多医生报告称推荐HPV疫苗时存在不一致、不及时或不紧急的情况。这些做法可能导致青少年免疫接种不足,并可能向家长传达矛盾态度。
作为首批评估建议质量多个方面的研究之一,这些发现可为众多旨在改善HPV疫苗沟通以解决强大癌症预防工具持续未得到充分利用问题的州和国家倡议提供参考。