- 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
- 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.
- National survey, pediatricians, family practice clinicians, July 2018-August 2018.
- Conference presentation, no peer review.