Making Effective HPV Recommendations Washington Chapter of the American Academy of Pediatrics Primary Care Provider Education Series Kristi Rice, MD Pediatrician, Northpointe Pediatrics Providence

Making Effective HPV Vaccine Recommendations

THIS ACTIVITY IS JOINTLY PROVIDED BY CARDEA AND WASHINGTON CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Institute for Medical Quality/California Medical Association (IMQ/CMA) through the joint providership of Cardea and Washington Chapter of the American Academy of Pediatrics. Cardea is accredited by the IMQ/CMA to provide continuing medical education for physicians. Cardea designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim credit commensurate with the extent of their participation in the activity.     

COMPLETING THIS ACTIVITY Upon successful completion of this activity 4.0 contact hours will be awarded Successful completion of this continuing education activity includes the following: Attending the entire CE activity; Completing the evaluation; Submitting an online CE request. Your certificate will be sent via email If you have any questions about this CE activity, contact Michelle Daugherty at mdaugherty@cardeaservices.org or 206- 729-4775    If there is no joint provider, you can put this slide later in the disclosures as appropriate.

CONFLICT OF INTEREST The planners and presenters of this activity have no relevant financial relationships with any commercial interests pertaining to this activity.    If there is no joint provider, you can put this slide later in the disclosures as appropriate.

Objective Learn an effective approach for recommending HPV vaccine Activities Review latest HPV vaccination practices Build skills for effective communication Practice the communication approach Announce

Connect, Clarify, Counsel Announce The child is due for 3 vaccines against several diseases HPV vaccination If parent hesitates… Connect, Clarify, Counsel © hpviq.org Announce

Review evidence

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

HPV vaccination recommendations On-time Ages 11 or 12, 2 doses Especially effective in younger adolescents All adolescents Late Age 15+, 3 doses Announce

Announce

Announce

HPV vaccination impact Sharp decline in cervical precancers in screened young women Age 21-24 62% Age 18-20 CIN2+: cervical intraepithelial neoplasia, grade 2 or more severe or adenocarcinoma in situ Gargano et al., 2017 Announce

HPV vaccine is safe Announce

Low HPV vaccine coverage in WA Healthy People 2020 Target up to date National Immunization Survey – Teen, 2016 Announce

Parents’ perceived importance of HPV vaccine What parents said HPV vaccine importance rating Healy et al., 2014, Vaccine 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 recommendations are uniquely powerful National Immunization Survey – Teen, 2013. Lindley et al., 2016 Announce

Provider recommendations are uniquely powerful No recommendation 35% National Immunization Survey – Teen, 2013. Lindley et al., 2016 Announce

Provider recommendations are uniquely powerful With recommendation 65% National Immunization Survey – Teen, 2013. Lindley et al., 2016 Announce

Presumptive announcements work Announcement approach training A 5.4% increase in HPV vaccine initiation by 3 months. Brewer, et al., 2017, Pediatrics Announce

Build skills

Announcement Approach The child is due for 3 vaccines against several diseases HPV vaccination If parent hesitates… Connect, Clarify, Counsel © hpviq.org Announce

Now that Sophia is 12, she is due for three vaccines. Announce Note child’s age. Announce children this age are due for vaccines that prevent several diseases, placing HPV cancers in middle of list. Say you will vaccinate today. Move on with the visit. Now that Sophia is 12, she is due for three vaccines. Today, she’ll get vaccines against meningitis, HPV cancers, and whooping cough. © hpviq.org Announce

If a parent hesitates… Clarify Connect Counsel Use an evidence-based message to addresses their concern. Counsel Give a reason to vaccinate. Clearly recommend getting HPV vaccine today. Connect Ask the parent for their main concern. Show the parent you are listening. © hpviq.org Announce

Clarify Connect Counsel Announce What’s your main concern about HPV vaccine? But kids respond more strongly to HPV vaccine when they are younger. This may give better protection against some cancers. Clarify I think we can wait until Sophia is a little older, don’t you? Connect I get it, Sophia is young. I can see why you may be worried that she isn’t ready for HPV vaccine. Counsel I strongly believe in the importance of this cancer-preventing vaccine for Sophia. I recommend she get it today. © hpviq.org Announce

Messages for the Clarify step Age. “Kids respond more strongly to HPV vaccine when they are younger. This may give better protection against some cancers.” Sex. “This really isn’t about sex. The HPV vaccine is about preventing cancer.” Safety. “This vaccine is one of the most studied medications on the market. The HPV vaccine is safe, just like the other vaccines given at this age.” Effectiveness. Guidelines. Vaccine for boys. School requirements. Additional messages are on the card in your materials © hpviq.org Announce

Demonstration

Tip 1. Treat HPV vaccine like other vaccines Bundle adolescent vaccine recommendations. If a parent only wants “required” vaccines, redirect them by saying that all 3 are equally important. Or you could say: I hear you. You’re wondering if the HPV vaccine is necessary because it’s not required for school. But school requirements don’t always keep up with medical science. The HPV vaccine is an important vaccine that can prevent many cancers. © hpviq.org Announce

Tip 2. Focus on cancer prevention HPV vaccine prevents 6 cancers. If sex comes up, redirect the discussion to cancer. My child doesn’t need this vaccine because she’s not having sex. I get it. Your child is not yet sexually active. The thing is, this really isn’t about sex. The HPV vaccine is about preventing cancer. © hpviq.org Announce

Tip 3. Follow-up with parents who say “no” Most parents get to yes. For parents who decline, ~Half get HPV vaccine later ~Another quarter plan to do so If a parent declines, bring it up at the next visit. Kornides, et al., 2018, Academic Pediatrics © hpviq.org Announce

Practice

Exercise 1. Create an announcement Note child’s age. Announce children this age are due for vaccines that prevent several diseases, placing HPV cancers in middle of list. Say you will vaccinate today. 2. Review the messages for the Clarify step © hpviq.org Announce

Exercise 3. Use the Announcement Approach Child Provider 11 years old Recommend HPV vaccination Go through all the steps beginning with the announcement you just created Vaccine-hesitant parent Be tough! And don’t quickly say yes Voice the concern the provider chose Evaluate the recommendation Child 11 years old In clinic for routine well visit; no serious health issues Has not had meningitis, HPV, or Tdap vaccines © hpviq.org Announce

How’d it go? © hpviq.org Announce

Next steps Use the Announcement Approach 5 patients in the next 2 weeks. Talk to your colleagues Agree on how providers and staff will communicate about HPV vaccine © hpviq.org Announce

Connect, Clarify, Counsel Announce The child is due for 3 vaccines against several diseases HPV vaccination If parent hesitates… Connect, Clarify, Counsel © hpviq.org Announce

Thank you! © 2018 hpviq.org. All rights reserved. Developed by Dr. Noel Brewer, University of North Carolina