Making Effective HPV Vaccine Recommendations Announce

Disclosures Presenter COI Planners COI Funding for this training [Insert] Planners COI Funding for this training [Insert] Announce

Clinicians are uniquely influential Announce

Objective Learn an effective strategy for recommending HPV vaccine Activities Review latest HPV vaccination practices Build skills for effective communication Practice the communication strategy Complete post-training survey for CME credit Announce

Review evidence

HPV-related disease incidence President’s Cancer Panel Annual Report (2014) Announce

HPV vaccination guidelines On-time 2 doses, ages 11 or 12 More effective than expected in younger adolescents Universal vaccination is most effective Late Females and MSM to age 26 Males to age 21 Announce

HPV vaccination impact Near-eradication of genital warts in Australia HPV vaccination available for females 88% BMJ (Ali et al., 2013) Announce

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9-valent vaccine FDA approved Give the HPV vaccine you have in stock Advise parents: don’t delay protection Announce

Low HPV vaccine coverage in NC Healthy People 2020 Target *3 doses National Immunization Survey – Teen, 2014 Announce

53,000 unnecessary new cervical cancer cases Missed opportunities HPV vaccine initiation, girls 53,000 unnecessary new cervical cancer cases MMWR (CDC, 2012) Announce

Parents’ perceived importance of HPV vaccine According to parents Vaccine (Healy et al., 2014) Announce

Parents’ reasons for not getting HPV vaccine Not knowing enough Safety concerns/side effects Not necessary No provider recommendation National Immunization Survey – Teen, 2013. (Stokley et al., 2014) Announce

Provider recommendation 55% 1% AJPH (Reiter et al., 2013) Announce

Clinicians are uniquely influential Announce

Questions? Announce

Build skills

Introducing vaccines 90% 17% Accepted vaccine Announcement “It’s time for shots.” 90% Optional “What do you want to do about shots?” 17% AJPH (Opel et al., 2015) Announce

Announce Ease main concern HPV vaccination Recommend child is due for 3 vaccines Ease main concern about HPV vaccine HPV vaccination Recommend HPV vaccine strongly Ask them to return in two months Announce © Dr. Noel Brewer, 2015

Announce Note child’s age. Announce the child is due for 3 vaccines recommended for children this age, placing HPV vaccine in middle of list. Say you will vaccinate today. Move on with the visit. Announce © Dr. Noel Brewer, 2015

Announce “I see here that Michael just turned 11. Because he’s 11, Michael is due for meningitis, HPV, and Tdap vaccines. We’ll give those at the end of today’s visit.” “Now that Michael is 12, there are three vaccines we give to kids his age. Today, he’ll get meningitis, HPV, and Tdap vaccines.” Announce © Dr. Noel Brewer, 2015

Ease main concern Elicit main concern about HPV vaccine Acknowledge main concern Share your commitment Educate on what research shows Elicit main concern about HPV vaccine Acknowledge main concern Share your commitment Educate on what research shows Announce © Dr. Noel Brewer, 2015

Ease main concern Elicit. “What’s your main concern about HPV vaccine?” “I think we can wait until Bianca is a little older, don’t you?” Acknowledge. “I get it, Bianca is young. I can see why you may be worried that she isn’t ready for HPV vaccine.” Share your commitment. “Because preventive care for kids Bianca’s age is important to me, I keep up-to-date on vaccine studies and I follow CDC guidelines for vaccination.” Educate on what research shows. “Children Bianca’s age should get HPV vaccine because younger children develop better protection. We want her to get the vaccine far before she is exposed to an infection that could lead to cancer. HPV vaccine is cancer prevention.” © Dr. Noel Brewer, 2015

Recommend Give motivational statement. End with the phrase “I recommend …” Encourage getting HPV vaccine today. Announce © Dr. Noel Brewer, 2015

Recommend “I strongly believe in the importance of this cancer-preventing vaccine for Michael. I recommend he get the HPV vaccine today.” “Kayla can get cervical cancer as an adult, but you can stop that right now. The HPV vaccine prevents most cervical cancers. I recommend Kayla get the HPV vaccine today.” Announce © Dr. Noel Brewer, 2015

Announce Ease main concern HPV vaccination Recommend child is due for 3 vaccines Ease main concern about HPV vaccine HPV vaccination Recommend HPV vaccine strongly Ask them to return in two months Announce © Dr. Noel Brewer, 2015

Questions? Announce

Demonstration

Announce Ease main concern HPV vaccination Recommend child is due for 3 vaccines Ease main concern about HPV vaccine HPV vaccination Recommend HPV vaccine strongly Ask them to return in two months Announce © Dr. Noel Brewer, 2015

Tips from your peers Focus on cancer prevention, not sex If sex or STIs come up, refocus on cancer prevention Treat HPV vaccine the same as required vaccines If the vaccine being “not required” comes up, refocus on recommendations being equally strong for all 3 vaccines Announce © Dr. Noel Brewer, 2015

Questions? Announce

Practice

Exercise 1. List three situations when you already use announcements as part of your routine clinical care. 2. Create an announcement Note child’s age. Announce the child is due for 3 vaccines recommended for children this age, placing HPV vaccine in middle of list. Say you will vaccinate today. Announce

Role-playing the provider Effectively recommend HPV vaccine Child 11 years old In clinic for routine well visit; no serious health issues Hasn’t gotten meningitis, HPV, or Tdap vaccines Role-playing the parent “Not necessary” “Sends message that sex is okay” Announce

How’d it go? Announce

How will you use the strategy with your patients? Announce

HPV vaccination is a team effort Align your communication Consider other activities Announce

Next steps for vaccine prescribers Use the communication strategy Commit to applying to your practice Set a goal Announce

CME credit Complete yellow CME survey Don’t forget your CME certificate of participation Announce

Thank you! © 2015 University of North Carolina. All Rights Reserved. Developed by Dr. Noel Brewer