Advice For Doctors Talking To Parents About HPV Vaccine: Make It Brief

Dec 5, 2016
Originally published on December 7, 2016 2:36 pm

A full decade after the Food and Drug Administration approved a vaccine to fight the sexually transmitted, cancer-causing human papillomavirus, almost half of all adolescents have still not received their first dose. This low vaccination rate is dramatic when compared to other routine childhood immunizations like polio and measles, mumps and rubella, where compliance is above 90 percent.

In order to boost HPV vaccination, doctors should be more assertive when bringing up the topic with parents, says Noel Brewer, a health and behavior scientist at the University of North Carolina. Brewer knew from earlier research that doctors contribute to that low vaccination rate because "most doctors and parents don't want to talk about sex," he says, especially when children are 11 or 12 — the age at which the Centers for Disease Control and Prevention recommends the vaccine be given.

Brewer wanted to figure out a better way for physicians to communicate the value of the vaccine to parents. So he conducted a study involving 30 North Carolina pediatric and family medicine clinics. The clinics were each divided into three groups of doctors. One group was trained how to make brief statements that assumed parents were ready to have their child vaccinated. This involved saying short, direct sentences such as, "Now that Michael is 12 there are three vaccines we give to kids his age. Today he'll get meningitis, HPV and Tdap [tetanus, diphtheria, pertussis]."

Another group of clinic doctors was trained to engage parents in somewhat lengthy discussions about the timing, safety and effectiveness of the vaccine. A control group of doctors received no training.

It turns out that more talk is less effective: When doctors made brief statements that presumed parents intended to vaccinate their child, vaccine rates increased by 5 percent. There was no increase in vaccination rates following the lengthy discussions. There was also no increase in the control group.

The straightforward approach — when the message is short, direct and brief — makes the HPV vaccine just like any other vaccine recommendation, Brewer says.

"Having a long conversation seems to communicate that there's a problem with the vaccine, and that worries parents," he says.

The study findings are published online Monday in the journal Pediatrics.

Something else that may help boost HPV vaccination rates is a recent recommendation from the Centers for Disease Control to reduce the number of doses for younger children. Because the vaccine is more effective at ages 11 and 12, the CDC now recommends only two doses instead of three. However, if children don't get vaccinated until age 15, they'll still need the full three doses.

"The HPV vaccine is an amazing tool to protect our younger generation against many types of cancer," says Dr. Margaret Stager, a pediatrician with Metro Health Medical Center in Cleveland and a spokesperson for the American Academy of Pediatrics. She says strains of HPV are responsible for the vast majority of HPV-related cancers, including cervical cancer and cancers of the anus, vagina and penis. It can also cause cancer in the back of the throat. So it's an important vaccine for both girls and boys, she says.

Preventing cancer should be the critical take-home message for parents, according to Stager. After all, she says, "HPV prevalence has already decreased as much as 65 percent among vaccinated youth, dramatically lowering the odds they will face a life-threatening form of cancer in adulthood."

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The HPV vaccination is recommended for children ages 11 or 12 and prevents numerous cancers in adulthood, but rates of vaccination are low. New research suggests that doctors should be more assertive when recommending the vaccine. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: The HPV vaccine fights a virus - the human papilloma virus - that's sexually transmitted. Earlier research shows that's what makes doctors uncomfortable talking to parents of young adolescents. Behavior scientist Noel Brewer with the University of North Carolina.

NOEL BREWER: Every health care provider has a story they can tell about a difficult conversation with a parent. They remember these and these difficult conversations become larger than life.

NEIGHMOND: So Brewer wanted to know how doctors could talk more effectively with parents and get more kids vaccinated. He studied two approaches. One - open ended, encouraging discussion and questions. The other - a short, simple statement.

BREWER: Now that Michael is 12, there are three vaccines we give to kids his age. Today he'll get meningitis, HPV and Tdap vaccines.

NEIGHMOND: Tetanus, diphtheria, pertussis - Brewer found these simple direct statements meant more kids got the vaccine. The open-ended discussion didn't make any difference. The message for doctors...

BREWER: Tell parents about HPV vaccine just like they would about any other vaccine.

NEIGHMOND: And maybe more children will be protected from this dangerous cancer-causing virus. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.