The Content and Context of Physicians' Communication with Males about Human Papillomavirus Vaccination

Although routine vaccination with quadrivalent human papillomavirus (HPV) vaccine for males ages 11-12 years in the United States (US) is recommended, HPV vaccine coverage among this population is low. A physician's recommendation for HPV vaccine is a key predictor of vaccine uptake; however, little is known about how physicians communicate about HPV vaccine with male patients. Thus, this study assessed the content and context of HPV vaccine communication with male patients of vaccine-eligible age (9-26 years) and their parents among a statewide sample of paediatricians and family medicine physicians in Florida, US.

The researchers received 367 completed surveys (50.7% response rate), which was about equally comprised of female and male physicians. Key findings:

• Few physicians (29.9%) reported they typically present HPV vaccine as routine to males ages 11-12 years, who constitute the target group for routine vaccination; an additional 20.9% reported they do not discuss HPV vaccine with this age group. For all age groups, more physicians reported they presented HPV vaccine as an optional, rather than routine, vaccine.
• When discussing HPV vaccination with male patients and their parents, many physicians reported somewhat or strongly emphasising cancer prevention (80.0%), sexually transmitted infection (STI) prevention (77.8%), the importance of vaccinating prior to the onset of sexual activity (77.2%), vaccine safety (68.5%), and vaccine efficacy (64.5%). Only 22.5% strongly emphasised that HPV vaccine can prevent anal cancer and possibly prevent penile cancer. More physicians highlighted HPV vaccine's cancer prevention benefits for female sexual partners than for the male patient himself.
• Although the Centers for Disease Control and Prevention (CDC) suggests that physicians recommend HPV vaccine the same way as other adolescent vaccines, in this study, over half of physicians reported recommending HPV vaccine less strongly than Tdap and meningococcal vaccines.
• Physicians most often discussed HPV vaccine when they saw patients for well-child visits (93.0%) and least often at acute care visits (15.3%). (The researchers call these missed opportunities for discussion particularly worrisome, because boys' compliance with well-child visit recommendations declines after age 12, and teenage boys usually visit a healthcare provider as a result of acute illness or injury.)
• Over half reported that at least one other healthcare professional in their practice discusses (56.1%) or makes the initial recommendation for (54.9%) HPV vaccination. "Additional research is needed on non-physician healthcare providers' role in and needs for effectively communicating about HPV vaccination."

In short, many primary care physicians in this sample reported HPV vaccine communication practices that are inconsistent with national guidelines and evidence-based recommendations. They are presenting HPV vaccine as optional rather than routine and are missing opportunities to communicate with males about the vaccine. (The cross-sectional study design does preclude the ability to examine whether physician communication about HPV vaccine results in subsequent vaccine uptake.)

The findings identify areas for future interventions to improve physicians' HPV vaccine communication. These areas include helping physicians present HPV vaccine as a routine part of the adolescent vaccination platform at ages 11-12 when males are still presenting routinely for well-child care, and as a vaccine that prevents cancer; to take advantage of all clinical encounters, particularly acute visits; and to maximise the use of support offered by non-physician healthcare professionals in communicating about HPV vaccination with patients.