A couple of years ago, “epic fail” was the phrase my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself it was a harsh, but accurate assessment of my performance. And I was certainly motivated to practice on my own so that the next time, things would be different.
That same phrase came to mind as I read an October 2015 online article published in Cancer Epidemiology, Biomarkers & Prevention titled “Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey” (Nov:24[11];1673). The article describes well the poor performance of the medical community – primarily pediatricians and family physicians – in providing this vaccine. Another source, the most recent National Immunization Survey–Teen 2014, reports another alarming trend: HPV vaccine series initiation and completion continues to lag far behind what it should be.
Dr. Jason Terk
It came as no surprise to me that the journal article clearly showed what I have suspected for some time and what has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11- to 12-year-old boys and girls lies not at the feet of the antivaccine movement or hesitant parents. Rather, the failure belongs to us.
The article describes findings from an online survey sent to 2,368 pediatricians and family physicians in 2014. Respondents (776) self-reported their own performance on strength of endorsement (saying the vaccine is important), timeliness (recommending it at ages 11 and 12 years), consistency (recommending it routinely versus using a risk-based approach), and urgency (recommending same-day vaccination).
More than one-quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported they did not recommend it be given at 11-12 years of age. Amazingly, 59% stated they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine at the current encounter when discussing the HPV vaccine. Because this is self-reported data, these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.
Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. The physician’s lack of competency in communicating effectively – overtly and covertly – leads to a lack of an affirmative recommendation that is so important in any preventive intervention. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we can fix what is wrong with us. Only we can turn around this epic failure.
Physicians and other providers of medical care to adolescents can access resources to help themselves improve their provision of the HPV vaccine to their patients. One of the best collections of resources can be found online at the American Academy of Pediatrics' Champion Toolkit. This includes material from the Centers for Disease Control and Prevention and AAP as well as some illuminating video vignettes that illustrate the do's and don'ts of communicating with families about HPV vaccination. This must become part of our mission!
Dr. Terk is a pediatrician in Keller, Tx., and is the immediate past president of the Texas Pediatric Society.
*Updated 1/26/2016