Vielot Nadja A, Ballard Christine A P, St Jean Denise T, Page Sophie, Hammond Kelli, Thompson Peyton, Butler Anne M, Ranney Leah M
Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
Vaccine. 2024 Dec 2;42(26):126467. doi: 10.1016/j.vaccine.2024.126467. Epub 2024 Oct 29.
Human papillomavirus (HPV) vaccination is often refused by patients or caregivers. We conducted a mixed-methods study to understand how health care providers document HPV vaccination refusal and use this information in subsequent encounters.
Using electronic health records (EHR) in a public academic health system, we identified patients aged 9-17 years with documentation of refusal of a recommended vaccination in billing codes or clinic notes from October 15, 2015 and December 31, 2021. We summarized the number of encounters in which vaccination was refused; the incidence of HPV vaccination following an initial refusal; and the content of clinic notes describing HPV vaccination refusal. Next, we held focus groups with clinic personnel to understand strategies for documenting HPV vaccination refusal and holding future conversations about HPV vaccination.
Of 523 patients with a documented vaccination refusal, 351 (67 %) refused HPV. Of these, 88 (27 %) eventually received HPV vaccination; incidence of vaccination was not associated with the method used to document refusal in the EHR (ICD-10 code versus clinic note). From focus group discussions, we learned that providers usually make brief notes describing when HPV vaccination was offered and refused, and generally plan to recommend vaccination again at a subsequent encounter. Documenting specific reasons for refusal (e.g., patient age, a conflicting priority) was considered helpful to guide future conversations.
Patients who refuse HPV vaccination might accept vaccination in the future if providers continue to recommend it. Documenting the refusal in EHR can provide meaningful context to guide subsequent recommendations.
人乳头瘤病毒（HPV）疫苗接种常常遭到患者或其监护人拒绝。我们开展了一项混合方法研究，以了解医疗服务提供者如何记录HPV疫苗接种拒绝情况，以及在后续诊疗中如何利用这些信息。
利用一个公共学术医疗系统中的电子健康记录（EHR），我们识别出了年龄在9至17岁之间、在2015年10月15日至2021年12月31日的收费代码或临床记录中有推荐疫苗接种拒绝记录的患者。我们总结了疫苗接种被拒绝的诊疗次数；初次拒绝后HPV疫苗接种的发生率；以及描述HPV疫苗接种拒绝情况的临床记录内容。接下来，我们与临床工作人员进行了焦点小组讨论，以了解记录HPV疫苗接种拒绝情况以及就HPV疫苗接种进行后续沟通的策略。
在523名有疫苗接种拒绝记录的患者中，351名（67%）拒绝了HPV疫苗接种。其中，88名（27%）最终接种了HPV疫苗；疫苗接种率与EHR中用于记录拒绝情况的方法（ICD-10代码与临床记录）无关。从焦点小组讨论中我们了解到，医疗服务提供者通常会做简短记录，描述HPV疫苗接种何时被提供以及被拒绝的情况，并通常计划在后续诊疗中再次推荐接种疫苗。记录拒绝的具体原因（如患者年龄、相互冲突的优先事项）被认为有助于指导后续沟通。
如果医疗服务提供者继续推荐，拒绝HPV疫苗接种的患者未来可能会接受接种。在EHR中记录拒绝情况可为指导后续建议提供有意义的背景信息。
