Strong provider recommendation can make significant difference in HPV vaccination rates

At any point, 1 out of 4 people has at least one strain of Human papillomavirus (HPV), according to the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH), making HPV the most common sexually transmitted infection (STI).

HPV can cause cancer, specifically cervical, oral, vaginal, penile, anal and oropharyngeal (throat, head and neck). In fact, nearly all cervical cancer cases are caused by HPV. More than 90 percent of anal cancers are caused by HPV and 70 percent of oropharyngeal cancers.

The HPV vaccine is proven to prevent HPV infection, and in turn, prevent cancer.

Despite these glaring figures, vaccination rates remain low. According to the CDC, 6 in 10 girls are vaccinated for HPV, and only 4 in 10 boys.

Physician recommendations could make all the difference.

“Simply put, physicians have a lot of influence on whether or not adolescents receive the HPV vaccine. In fact, a provider’s recommendation is one of the strongest and most consistent predictors of HPV vaccination,” said Annie-Laurie McRee, Dr.PH., assistant professor in the Department of Pediatrics at the University of Minnesota Medical School. McRee is also a Masonic Cancer Center member.

For the past 8 years, McRee has studied the impact of provider recommendations for the HPV vaccine, and how that can affect whether or not parents and patients decide to vaccinate.

“Health care providers may not recommend the vaccine at all, or do so halfheartedly. Some may actually undercut their efforts to get preteens vaccinated by making weak or ambiguous recommendations,” McRee said.

In fact, McRee said her research has found:

  • About one-fourth of Minnesota health care providers reported they do not routinely recommend HPV vaccination for 11 and 12-year-old girls (based on a statewide survey of 575 care providers)
    • And, more than half of those health care providers say they do not recommend HPV vaccination for boys
  • Nearly 2 out of 3 health care providers reported offering the HPV vaccine as optional for either sex
  • Instead of following a solely age-based recommendation, many health care providers reported “gently” broaching the topic of HPV vaccination on-time, but delayed making a stronger recommendation until older adolescence, or based on their perception of the patients’ risk of sexual debut

Additional research shows a lack of a provider’s recommendation can contribute to a parents’ reasoning for not vaccinating. The CDC’s annual National Immunization Survey-Teen showed 15 percent of parents who said they would not be getting their child vaccinated stated not receiving a health care provider recommendation as the primary deciding factor.

“Levels of vaccination are below where they should be for both boys and girls,” McRee said. “The HPV vaccine is a safe and effective prevention strategy against several different types of cancer. HPV is extremely common. Most people get HPV at some point in their lives.”

McRee’s research demonstrates the importance of a strong health care provider recommendation for the vaccine. So, how do health professionals implement that into practice?

McRee provided these guidelines:

  • Recommend HPV vaccine according to guidelines
    • That is, for all 11 to 12-year-olds, not just people who appear to be at risk
  • Stress the importance of vaccination
  • Emphasize the cancer prevention benefits of the vaccine
  • Offer the HPV vaccine in tandem with other recommended adolescent vaccines
  • Suggest vaccination on the same day as the visit, rather than another day
  • Consider all clinical encounters as potential opportunities for vaccination, not just preventative care check-ups.

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