Least important and last on the list: Physicians' communication about HPV vaccination

Background. Human papillomavirus (HPV) vaccine uptake remains far below the Healthy People 2020 goal of 80% coverage, and stands in stark contrast to our success in delivering other adolescent vaccines. Because improving physicians' communication about HPV vaccine is critical to raising coverage, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type.

Methods. Pediatricians and family physicians (n=776) completed our national online survey in 2014. We assessed physicians' perceptions and communication practices related to recommending adolescent vaccines for 11- to 12-year-old patients.

Results. Most physicians reported recommending tetanus, diphtheria, and acellular pertussis (Tdap) (95%) and meningococcal vaccines (87%) as highly important for adolescents, but fewer strongly endorsed HPV vaccine (73%, both p<0.001). Only 13% of physicians perceived HPV vaccine as being highly important to parents, which was far fewer than for Tdap (74%) or meningococcal vaccines (62%, both p<0.001). Physicians reported that, on average, discussing HPV vaccine took 3.7 minutes (SE=0.12), which was almost twice as long as their estimates for Tdap. Among physicians with a preferred order for discussing adolescent vaccines, most (70%) discussed HPV vaccine last.

Conclusions. Our findings suggest that physicians perceive HPV vaccine discussions to be burdensome, requiring more time and engendering less parental support than other adolescent vaccines. Perhaps for this reason, physicians in our national study endorsed HPV vaccine less strongly than other adolescent vaccines, and often chose to discuss it last. Communication strategies are needed to support physicians in recommending HPV vaccine with greater confidence and efficiency.