Pediatricians Give Parents Mixed Messages About HPV Vaccination

May 22, 2017

By Will Boggs MD

NEW YORK (Reuters Health) - Pediatricians often give parents mixed messages about the need for vaccination against human papillomavirus (HPV), according to a new analysis of audio recordings.

"Physicians in our study appeared to anticipate and exaggerate parental resistance to HPV vaccination, leading them to be hesitant and give ‘mixed messages’ about HPV vaccine,” Dr. Lynne Sturm from Indiana University School of Medicine, in Indianapolis, told Reuters Health by email. “That is, a provider might recommend the vaccine for the child, but then offer to delay the vaccine until a later date. This was probably confusing to parents.”

Previous studies have shown that parents commonly report lack of physician offer/recommendation of HPV vaccine or physician acceptance of parental wish to delay as the reasons for non-vaccination, and many physicians do not meet such quality indicators as making a recommendation that is strong, timely (vaccination by ages 11-12 years), consistent across the patient panel and urgent (same-day rather than delayed).

Dr. Sturm's team used quantitative and qualitative analyses of audio recordings/transcripts of full clinical encounters between pediatricians, 11- to 12-year-old patients, and their caregivers to evaluate the association between pediatrician communication approaches and agreement to same-day HPV vaccination.

Only 29% of visits resulted in same-day vaccine acceptance, the researchers report in the Journal of Adolescent Health, online April 25.

Pediatricians were often inconsistent in their communication approaches across patients, made recommendations alongside an offer/recommendation to delay (thereby diluting the initial recommendation) and treated HPV vaccine differently from Tdap and meningococcal conjugate vaccine.

They commonly portrayed non-HPV vaccines as routine or required by school/camp but HPV vaccine as optional, a matter of parent choice.

A few pediatricians discussed HPV vaccine as they did other vaccines, using a brief, matter-of-fact presumptive style, with HPV vaccine at the end of a list of vaccines for which the child was "due." Their recommendations tended to be strong even in cases where they accommodated the parent's desire to delay.

Misinformation about the duration of protection was common, and back-and-forth dialogue about HPV vaccine was not the norm. Pediatricians typically acquiesced in the face of caregiver hesitancy or concern about possible side effects of HPV vaccine.

HPV vaccine acceptance was 73% when pediatricians used presumptive language, but was only 22% when presumptive language was not used.

Caregivers agreed to vaccinate 82% of the time when delay was not mentioned but only 6% of the time when delay of vaccination was offered or recommended.

Strength of recommendation and pediatrician reference to vaccinating their own children, however, were not associated with HPV vaccine acceptance.

“We hope physicians will appreciate how important they are to the families they serve and how vital their strong and unambivalent recommendation for HPV vaccination is to ensure that young adolescents receive this cancer-prevention vaccine at the same appointment when they receive Tdap and meningococcal ACWY vaccines (and seasonal influenza vaccine, depending on the timing),” Dr. Sturm said.

“Providing health care providers with better skills in communicating unambivalent recommendations could help to reduce mixed messages,” she said. “Providing skills from motivational interviewing for talking with hesitant parents also looks promising.”


J Adolescent Health 2017.