title: Physician communication about adolescent vaccination: How is human papillomavirus vaccine different?
abstract: BACKGROUND
  Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type.
  
  
  METHODS
  A national sample of 776 U.S. physicians (53% pediatricians, 47% family medicine physicians) completed our online survey in 2014. We assessed physicians' perceptions and communication practices related to recommending adolescent vaccines for 11- and 12-year-old patients.
  
  
  RESULTS
  About three-quarters of physicians (73%) reported recommending HPV vaccine as highly important for patients, ages 11-12. More physicians recommended tetanus, diphtheria, and acellular pertussis (Tdap) (95%) and meningococcal vaccines (87%, both p<0.001) as highly important for this age group. Only 13% of physicians perceived HPV vaccine as being highly important to parents, which was far fewer than perceived parental support for Tdap (74%) and meningococcal vaccines (62%, both p<0.001). Physicians reported that discussing HPV vaccine took almost twice as long as discussing Tdap. Among physicians with a preferred order for discussing adolescent vaccines, most (70%) discussed HPV vaccine last.
  
  
  CONCLUSIONS
  Our findings suggest that primary care physicians perceived 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 recommended 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.
authors.affiliation: Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 133 Brookline Ave., Boston, MA 02215, USA. Electronic address: gilkey@email.unc.edu.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7440, Chapel Hill, NC 27599, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.affiliation: Department of Pediatrics and Internal Medicine, School of Medicine, University of North Carolina, Campus Box 7220, Chapel Hill, NC 27599, USA.
authors.forename: Tamera
authors.initials: T
authors.lastname: Coyne-Beasley
authors.affiliation: Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7440, Chapel Hill, NC 27599, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Hall
authors.affiliation: Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7440, Chapel Hill, NC 27599, USA.
authors.forename: Parth D
authors.initials: PD
authors.lastname: Shah
authors.affiliation: Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7440, Chapel Hill, NC 27599, USA.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D003142:Communication; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines; D010290:Parents; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines
keywords: Adolescent health; Health communication; Human papillomavirus infections/prevention & control; Quality of health care