Primary Care Physicians' Perceptions About HPV Vaccination — Another Missed Opportunity?

January 20, 2016

Primary Care Physicians' Perceptions About HPV Vaccination — Another Missed Opportunity?

  1. Louis M. Bell, MD

Pediatricians and family physicians often did not strongly encourage patients (and parents) about receiving the HPV vaccine.

  1. Louis M. Bell, MD

Vaccination against human papillomavirus (HPV) is recommended beginning at age 11 to 12. However, only 40% of U.S. girls and 22% of boys aged 13 to 17 years receive all three doses of vaccine. As HPV is a sexually transmitted infection, discussions with families can be challenging. Researchers conducted a national survey of 829 pediatricians and family physicians (FPs) to gauge opinions about and barriers to HPV vaccination. Participants were queried about their habits in recommending the HPV vaccine, how commonly parents requested deferral of HPV vaccination, and why they or parents might not want to discuss the need for vaccination.

The overall response rate was 70%, with more pediatricians (82%) than FPs (56%) answering. Almost all pediatricians and 87% of FPs reported administering the HPV vaccine to girls aged 11 to 18 years, whereas 98% of pediatricians and 81% of FPs did so for boys. In general, the vaccine was more strongly recommended to patients aged 13 to 15 years than to those aged 11 to 12 years, and girls were more strongly encouraged to receive HPV vaccination than boys. More than half of physicians reported that ≥25% of parents deferred vaccinations for their 11-to-12-year-old children. White, suburban families with private insurance had the highest frequency of postponement. One third of pediatricians and one half of FPs did not always discuss HPV vaccination at the 11-to-12-year visit. Among physicians who chose not to discuss HPV vaccination at this age, 54% thought the patient was not sexually active, 38% thought the patient was too young, 35% noted that the patient was already receiving other vaccines, and 29% expected the parents to refuse.

Comment

Pediatricians and family physicians may overestimate the likelihood that parents will refuse HPV vaccination for their preteen children, and therefore don't discuss it during the 11-to-12-year visit. This is a missed opportunity. Our perceptions of parental attitudes are not always accurate, and a strong recommendation by a trusted primary care provider is often most influential for initiating and completing the HPV vaccine series.

Editor Disclosures at Time of Publication

  • Disclosures for Louis M. Bell, MD at time of publication Grant / Research support NIH Institutional Clinical and Translational Science Award; AHRQ National Center for Pediatric Practice Based Research Learning; Patient-Centered Outcomes Research Institute Editorial boards Current Problems in Pediatric Adolescent Healthcare, Associate Editor

Citation(s):

Reader Comments (2)

Louis Bell Other, Article author

I have great faith in my primary care colleagues and their ability to not only care for children with illnesses but also to provide preventive services to their patients with our system of vaccine delivery being the best example. The challenge with HPV vaccination, in particular, is that only 40% of U.S. girls and 22% of boys aged 13 to 17 years receive all three doses of what is a safe , effective and cancer preventing vaccine. So there are indeed many missed opportunities. I also believe the old adage “a bird in the hand is worth two in the bush”. I was simply advocating to be as aggressive as possible ( within reason and judgement) to begin HPV vaccination as early as possible in order to improve the overall health impact of the HPV vaccine.

Lou

Kurt Elward Physician, Family Medicine/General Practice, Private Practice

I bring up the HPV vaccine at the recommended time, but also respect parents decisions to forego at 11-12. I know this is heretical to the vaccine community, but waiting until 13-15 in many children give us an opportunity to discuss with the teen why they need this vaccine, why it is not STD bullet proof, and validate other prevention and avoidance education. Few if any 11-12 year olds can process this information. Moreover, the completion rates in our practice seem better at later ages.

I do let the parents know that many children their kids age are already sexually active and this is why it is recommended to be given when it is. At the same time, I think it is counterproductive to beat up on the parents and simply feeds into vaccine paranoia. In most cases I believe that judicious waiting until 13-15 can be a very wise strategy. I also realize that most vaccine experts have very little faith in the primary care physician population especially when you are seeing at or over 90% vaccination rates and still complaining about missed opportunities.

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