October 25, 2018, 03:43 pm Michael Devitt – Family physicians don't always appreciate the effect they can have on the choices people make. Sometimes a carefully chosen word or phrase can end up making all the difference in a patient's life.
Case in point: A new study in the October edition of the Journal of Immigrant and Minority Health shows that primary care physicians can effectively communicate with parents about having their children vaccinated against HPV. The study's results indicate that for many parents, a physician often is the primary source of information about the HPV vaccine, and that a physician's recommendation frequently determines whether a parent has their child vaccinated against the virus.
The study was conducted at two family medicine clinics (one urban, one suburban) that serve predominantly Hispanic patient populations. Forty-one percent of the family physicians at the clinics were Hispanic, and 63 percent of the physicians spoke Spanish.
The parents of all patients 18 and younger who presented at either clinic for an annual well-child visit received a five-question survey designed to test their knowledge about HPV. The surveys, which were available in both English and Spanish, were distributed in the summer of 2014 by front desk personnel in each of the clinics.
Researchers collected a total of 495 surveys. Most surveys (82 percent) were completed by mothers; 65 percent of respondents were covered by Medicaid and 93 percent had no personal history of HPV. Fifty-one percent of the patients were female, 74 percent were Hispanic, and 78 percent were between 9 and 15 years of age.
Analysis of the surveys showed that although most parents (56 percent) knew that HPV can cause warts and cervical cancer, 61 percent did not know or disagreed with the belief that the HPV vaccine prevents cancer, and 58 percent were unsure or did not know that the HPV vaccine is approved for both boys and girls.
Although 43 percent of parents reported that they already had intended to vaccinate their child with the HPV vaccine, an equal percentage said they were undecided or not sure about having their child vaccinated at the time they took the survey.
Results showed that where a parent learned about the HPV vaccine was a significant factor in the decision to vaccinate their child. Forty-four percent of respondents first learned about the HPV vaccine at their doctor's office, compared with 30 percent who first heard about the HPV vaccine on television.
Among parents who reported an intent to vaccinate their children, those who first learned about the HPV vaccine in their doctor's office were 2.07 more likely to vaccinate their children than those who first learned about it from friends or other sources (e.g., a newspaper or the internet), and 3.31 times more likely to vaccinate compared with those who first learned about the vaccine on television. It's also notable that more parents had made the decision to have their daughters vaccinated than their sons (52 percent versus 39 percent).
The study authors stressed three take-home points from their findings.
First, primary care physicians should talk with parents about HPV and the benefits of the HPV vaccine at each well-child visit, especially when the child is between 11 and 18.
Second, physicians should be more proactive in educating parents about preventive care for their children, particularly as it pertains to vaccination. Physicians also should make education a part of every well-child visit so that they can cover a wide range of topics over an extended period of time.
Third, physicians should recognize that there may be specific knowledge gaps among Hispanic parents with regard to HPV and the HPV vaccine and take appropriate steps to ensure that parents have all of the information they need when deciding whether to vaccinate their children.
This last point is especially important given the evidence that Hispanic women have the highest incidence of new cases of cervical cancer and the second-highest mortality rate from cervical cancer in the United States.
Despite all the evidence regarding the effectiveness of vaccination, some parents may express concerns about having their children vaccinated. Jennifer Frost, M.D., medical director for the Academy's Health of the Public and Science Division, emphasized the importance of simple, direct communication in these situations.
"It is well known that a recommendation from their personal physician is the strongest predictor of whether a patient gets a vaccine," Frost told AAFP News. "How we communicate that recommendation matters. Family physicians should make a simple and strong recommendation for all vaccines.
"But I have heard both physicians and nurses treat the HPV vaccine differently, getting caught up talking about sex rather than the clear benefits of vaccination. The HPV vaccine prevents cancer, and that should be the focus."
"This can be particularly hard if there is a language barrier," Frost added. "Ideally, if there is a language barrier, a professional interpreter should be used. But in reality, that's not always an option. Again, keeping the information simple is key."
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