PAS 2019—When recommending the HPV vaccine, clinicians need style and strength


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • When recommending the HPV vaccine for 11-12-year-olds, pediatricians and family practice doctors might alter the strength and style of their recommendation in ways that affect uptake.
  • Anticipation of refusal might result in unconscious modulation of the strength of the recommendation.

Why this matters

  • Series completion rates for this cancer-preventing vaccine remain low, at

Key results

  • 83% report strongly recommending the vaccine for this age group.
  • Clinicians usually focus on prevention of cancer and genital warts.
  • 65% of pediatricians, 42% of family practice doctors report using a “presumptive” style—showing an expectation that the child will be getting the vaccine.
  • 40% overall use standing orders; 66% have a system to identify unvaccinated children; 42% have a system for flagging.
  • Refusal/deferral rates are high for this age group.
  • 50% or greater refusal/deferral was linked to: 
    • Not “strongly recommending” the vaccine: risk ratio, 1.88 (95% CI, 1.40-2.52); and
    • Not using a presumptive style always/almost always: 1.70 (1.22-2.37).
  • Where clinicians experience high rates of refusal, they may be changing the strength or framing of recommendations, anticipating resistance.
  • Refusers cite misinformation from social media, concerns about safety.

Study design

  • National survey, pediatricians, family practice clinicians, July 2018-August 2018.

Limitations

  • Conference presentation, no peer review.

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