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Clinician communication strategies associated with increased uptake of the human papillomavirus (HPV) vaccine: A systematic review.

Literature Information

DOI	10.3322/caac.21753
PMID	35969145
Journal	CA: a cancer journal for clinicians
Impact Factor	232.4
JCR Quartile	Q1
Publication Year	2022
Times Cited	18
Keywords	clinician, communication, human papillomavirus (HPV), provider, vaccination
Literature Type	Systematic Review, Journal Article, Research Support, Non-U.S. Gov't
ISSN	0007-9235
Pages	561-569
Issue	72(6)
Authors	Catherine Constable, Kyle Ferguson, Joey Nicholson, Gwendolyn P Quinn

TL;DR

This study reviews communication strategies used by healthcare clinicians to improve HPV vaccination rates, highlighting that strong and presumptive recommendations significantly enhance vaccine uptake. It emphasizes the importance of clinician influence on vaccination decisions and calls for further research on additional strategies like motivational interviewing and cancer-prevention messaging, given the low current vaccination rates among adolescents in the U.S.

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clinician · communication · human papillomavirus (HPV) · provider · vaccination

Abstract

Human papillomavirus (HPV) is currently linked to almost 35,000 new cases of cancer in women and men each year in the United States. Gardasil-9 (Merck & Company), the only HPV vaccine now available in the United States, is nearly 100% effective at preventing precancers caused by oncogenic HPV types. In the United States, however, only about one half of adolescents are up to date with HPV vaccination. It is well known that health care clinicians' recommendations play a significant role in parents' decisions regarding HPV vaccination. A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the evidence for each of these strategies is needed. The authors searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Complete databases for original articles with a defined clinician communication strategy and an outcome of HPV vaccine uptake or intention to vaccinate (PROSPERO registry no. CRD42020107602). In total, 46 studies were included. The authors identified two main strategies with strong evidence supporting their positive impact on vaccine uptake: strong recommendation and presumptive recommendation. Determinations about a causal relationship were limited by the small numbers of randomized controlled trials. There is also opportunity for more research to determine the effects of motivational interviewing and cancer-prevention messaging.

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Primary Questions Addressed

1. What are the specific elements of strong and presumptive recommendations that make them effective in increasing HPV vaccination rates?
2. How do different demographic factors (e.g., age, socioeconomic status) influence the effectiveness of clinician communication strategies for HPV vaccination?
3. What role do parents' beliefs and attitudes play in their response to clinician recommendations for HPV vaccination?
4. How can motivational interviewing be integrated into existing clinician communication strategies to further enhance HPV vaccine uptake?
5. What additional research is needed to explore the long-term effects of various communication strategies on HPV vaccination rates across different populations?

Key Findings

Key Insights

1. Research Background and Objectives:
   The study addresses a critical public health issue regarding the underutilization of the HPV vaccine, which is responsible for approximately 35,000 new cancer cases annually in the United States. Despite the high efficacy of Gardasil-9 in preventing oncogenic HPV-related precancers, only about 50% of adolescents are fully vaccinated. Recognizing that clinician recommendations significantly influence parental decisions about HPV vaccination, the authors aimed to systematically review communication strategies employed by clinicians to enhance vaccine uptake.

2. Major Methods and Findings:
   The authors conducted a comprehensive literature search across multiple databases, including PubMed and Cochrane, focusing on original studies that examined clinician communication strategies and their impact on HPV vaccine uptake or the intention to vaccinate. The review included 46 studies, revealing two primary communication strategies that exhibited strong evidence of efficacy: strong recommendation and presumptive recommendation. Strong recommendations involve clinicians explicitly advising vaccination, while presumptive recommendations assume the vaccine will be received unless the parent objects. However, the authors noted that the determination of causal relationships was constrained by the limited number of randomized controlled trials available. Additionally, they identified a need for further research into the effects of motivational interviewing and cancer-prevention messaging as potential strategies.

3. Core Conclusions:
   The review concluded that clinician communication strategies, particularly strong and presumptive recommendations, are crucial in increasing HPV vaccination rates. These strategies effectively enhance parental acceptance and intention to vaccinate their children against HPV, thus contributing to public health efforts in cancer prevention. However, the authors highlighted the necessity for more rigorous research, especially randomized controlled trials, to better understand the impact of various communication techniques on vaccination uptake.

4. Research Significance and Impact:
   This systematic review underscores the pivotal role of clinician communication in public health initiatives aimed at increasing HPV vaccine uptake. The insights gained from this study can inform healthcare professionals and policymakers about effective strategies to encourage vaccination, ultimately aiming to reduce HPV-related cancer incidence. The findings advocate for enhanced training and resources for clinicians to adopt effective communication strategies in practice. Furthermore, the identification of gaps in research points to potential avenues for future studies, ensuring ongoing improvements in vaccination efforts and public health outcomes relating to HPV.

Literatures Citing This Work

1. Uptake of HPV vaccination among boys after the introduction of gender-neutral HPV vaccination in Germany before and during the COVID-19 pandemic. - Cornelia Wähner;Johannes Hübner;Dörte Meisel;Jörg Schelling;Rebecca Zingel;Sarah Mihm;Regine Wölle;Miriam Reuschenbach - Infection (2023)
2. Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series. - Sidika Kajtezovic;Jake R Morgan;Stephen Fiascone;Heather M Brandt;Rebecca B Perkins - Human vaccines & immunotherapeutics (2023)
3. HPV vaccine recommendations by age: A survey of providers in federally qualified health centers. - Paige Lake;Lindsay Fuzzell;Naomi C Brownstein;Holly B Fontenot;Alexandra Michel;McKenzie McIntyre;Ashley Whitmer;Sarah L Rossi;Rebecca B Perkins;Susan T Vadaparampil - Human vaccines & immunotherapeutics (2023)
4. How to make effective HPV vaccine recommendations starting at age 9. - Noel T Brewer;Benjamin Z Kahn;Katherine I Kritikos;Jennifer A Heisler-MacKinnon;Jessica D Young;Melissa B Gilkey - Human vaccines & immunotherapeutics (2023)
5. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. - Mia Ann Xu;Jasmin Choi;Ariadna Capasso;Ralph DiClemente - Healthcare (Basel, Switzerland) (2023)
6. Determinants of the Implementation of Human Papillomavirus Vaccination in Zambia: Application of the Consolidated Framework for Implementation Research. - Mwansa Ketty Lubeya;Carla J Chibwesha;Mulindi Mwanahamuntu;Moses Mukosha;Bellington Vwalika;Mary Kawonga - Vaccines (2023)
7. Benefits, challenges, and strategies related to using presumptive recommendations for HPV vaccination: A qualitative study with rural and non-rural-serving primary care professionals. - Olufeyisayo O Odebunmi;Lisa P Spees;Caitlin B Biddell;Tatenda Yemeke;Juan Yanguela;Colleen Higgins;Melissa B Gilkey;Sachiko Ozawa;Stephanie B Wheeler - Human vaccines & immunotherapeutics (2024)
8. Facilitators and barriers of HPV vaccination: a qualitative study in rural Georgia. - Courtney N Petagna;Stephen Perez;Erica Hsu;Brenda M Greene;Ionie Banner;Robert A Bednarczyk;Cam Escoffery - BMC cancer (2024)
9. Effect of an HPV Vaccination Multi-Level, Multi-Component Program on HPV Vaccination Initiation and Completion in a Pediatric Clinic Network. - Lara S Savas;Ross Shegog;Erica L Frost;C Mary Healy;Dale S Mantey;Sharon P Coan;L Aubree Shay;Travis A Teague;Juan J Ferreris;Sharice M Preston;Sally W Vernon - Vaccines (2024)
10. Clinician Communication Training to Increase Human Papillomavirus Vaccination Uptake: A Systematic Review and Meta-Analysis. - Nutthaporn Chandeying;Therdpong Thongseiratch - Vaccines (2024)

... (8 more literatures)

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