1. JUST ANOTHER SHOT: REFRAMING THE HPV VACCINE
From the MINNESOTA Department of Health
JUST ANOTHER SHOT: REFRAMING THE HPV VACCINE

2. Communication Strategies to Increase HPV Immunization Coverage
Sharon Humiston, MD, MPH, FAAP
Professor of Pediatrics
Children’s Mercy
Kansas City, MO
Office Staff
Parent & Child
Provider
EHR, IIS
This work was funded by a grant from the CDC to Hager Sharp Inc.

3. Learning Objectives
Identify and implement the “same way, same day” approach to HPV vaccination for all 11- & 12-year-olds (as well as older unvaccinated patients) in the pediatric health care setting.
Recruit your whole office team to take a role in HPV vaccination communication
Model other evidence-based strategies to increase HPV vaccination coverage in your office.
Introduce >2 new practice tools into to help support HPV vaccination in the pediatric health care setting.

4. Objective #1
“SAME DAY, SAME WAY”

5. Sometimes we send messages we did not intend to send.

6. Doctor: “What do you want to do about shots today?”
Parent: “Hmmm…What do you think we should do?”
Doctor: “Tdap is required for school and some colleges require the meningitis vaccine. There’s also an optional vaccine, HPV, we could give at this age.”
Parent: “That one isn’t required for school? Well, if it’s not really necessary, maybe we should hold off.”
Doctor: “Well…if you don’t want it…Okay. Emma is such a good kid…I’m sure it can wait ‘til next time.”

7. Recommend HPV vaccine the same day & the same way as other adolescent immunizations
Same day: Recommend HPV vaccine today, i.e., the same day you recommend Tdap & meningococcal vaccines.
Unpublished CDC data, 2013.

8. Recommend HPV vaccine the same day & the same way as other adolescent immunizations
Same day: Recommend HPV vaccine today, i.e., the same day you recommend Tdap & meningococcal vaccines.
More convenient for the parent
More reliable
Unpublished CDC data, 2013.

9. Recommend HPV vaccine the same day & the same way as other adolescent immunizations
Same day: Recommend HPV vaccine today, i.e., the same day you recommend Tdap & meningococcal vaccines. Same way: Bundle all the adolescent vaccines and recommend them all in the same way with the assumption that the parent will want protection for their child.
Unpublished CDC data, 2013.

10. Today, Michelle should have 3 shots that will protect her from the cancers caused by HPV, and infections causing meningitis, whooping cough, tetanus, & diphtheria. 
What questions do you have for me about these vaccines?

11. Notice that I’m recommending a presumptive style.
There’s some preliminary evidence that a “participatory” style is associated with lower vaccination uptake. Avoid starting with a bland inquiry like, “Let’s discuss how you feel about the vaccinations for adolescents.”

12. Use a practical communication strategy when a parent has a question
Vaccinate
Ask/
Respond
Recommend
ACKNOWLEDGE
Plan for next step
ADVISE

13. Use a practical communication strategy when a parent has a question
Vaccinate
Ask/
Respond
Recommend
When a parent has a question, don’t panic.
My 2 knee jerk rxns – feel like we’re heading into time-sucking conflict & feel like my authority’s being challenged
Interpret a question as a request for reassurance from YOU, a clinician they trust
ACKNOWLEDGE
Plan for next step
ADVISE

14. Be prepared to address specific concerns

15. Be prepared to address specific concerns

16. Use a practical communication strategy when a parent has a question
Vaccinate
Ask/
Respond
Recommend
ACKNOWLEDGE
Plan for next step
ADVISE

17. Use a practical communication strategy when a parent has a question
Vaccinate
Ask/
Respond
Recommend
DECLINE FOR NOW
ACKNOWLEDGE
Plan for next step
ADVISE

18. If a parent declines…
Declination is not final. The conversation can be revisited. Declining = Delaying
End the conversation with at least 1 action you both agree on.
Because waiting to vaccinate is the risky choice, many pediatricians ask the parent to sign a Declination Form

20. Putting it all together

21. Great job! He seized the moment
He did not “profile” (he recommended the vaccine even though this girl does not look like she’s interested in having sex soon)
He bundled the recommendation
He asked for mom’s question
He answered mom’s question accurately and calmly (if a bit long winded)
When mom asked the 2nd question: “some people…”, he stayed positive
He cared (“I’d feel better”)

22. “I don’t want to talk about sex.”

23. “I don’t want to talk about sex.”
Did you explain fecal-oral spread before you gave the polio vaccine?

24. Who Makes the HPV Decision?
Cross-sectional sample of women in SE Texas
With >1 child age 9-17 yrs in
31% 24%
Effect of the Decision-making Process in the Family on HPV Vaccination Rates among Adolescents 9-17 years of age. Human Vaccine Immunotherapy

25. Every part of your practice influences parents’ perceptions

26. Objective #2
Recruit your whole office team to take a role in HPV vaccination communication

27. Passion is energy

28. Be sure everyone in the office understands the mission
Human stories often influence people more than statistics
To understand the human stories behind HPV, listen to survivors
Shot By Shot
Unprotected People on

31. The Opener
Announce the child needs 3 vaccines (4 if flu vaccine is available)
Encourage convenient same-day vaccination
“Today, Pat should have 3 vaccines. They’re designed to protect him from the cancers caused by HPV and from meningitis, tetanus, diphtheria, & pertussis. What questions do you have for me?”
If a parents hesitates, the MA/nurse should say
“Our team is so dedicated to cancer prevention -- I’m sure the doctor will want to respond to your concerns.”

32. In your office, who has this role in i m m u n i z a t i o n c o m m u n i c a t i o n ?
Give the VIS
Explain the VISs
Answer questions if they arise
Vaccinate
Arrange for the next dose

33. other evidence-based strategies to increase HPV vaccination coverage
Objective #3
other evidence-based strategies to increase HPV vaccination coverage

34. How to improve: 2 Approaches
Increase the # of target patients who:
Come in
Leave the office vaccinated

35. Using reminder or recall messages
# who come in
Using reminder or recall messages
Timing
Reminder – to patients who will be due soon
Recall – to patients who are past due
Medium
Letter
Phone call – personal or auto-dialer
Text

36. By making access easier
# who come in
By making access easier
Office hours – e.g., one evening/week, Saturday mornings
Nurse only visits

37. # who leave vaccinated

38. Actual and Potentially Achievable Vaccination Coverage if Vaccines Were Given Simultaneously NIS-Teen, 2012

39. By vaccinating at every visit type
# who leave vaccinated
By vaccinating at every visit type
Well care
Chronic care
Acute care

40. 2. # who leave vaccinated Standing Orders
Empower non-physician personnel to vaccinate patients (after assessing for specific contra- indications) without direct physician involvement
Preapproved orders to vaccinate on file
Templates available for all routine vaccines at
To save physicians’ time, staff have to be aware of the S.O. and trained to use it

41. # who leave vaccinated
Provider Prompts
Prompt the person who is supposed to order the vaccine
How?
Nursing personnel
EHR
Both
Attention to prompts tends to wear off

42. Provider Prompts: QI

43. Objective 4
PRACTICE TOOLS

45. Email questions or comments to CDC Vaccines for Preteens and Teens:
For more information, including free resources for yourself and your patients/clients, visit: cdc.gov/vaccines/YouAreTheKey
questions or comments to
CDC Vaccines for Preteens and Teens:

47. For More Information Shot by Shot AAP
AAP
Info for parents (healthychildren.org)
Info for clinicians ( immunization/illnesses/hpv/hpv.html)
Immunization Action Coalition
CHOP Vaccine Education Center
EZ IZ
American Cancer Society

48. FREE!

50. Review
Use the “same way, same day” approach to HPV vaccination for all 11- & 12-year-olds and older unvaccinated patients.
Recruit your whole office team – heart and mind – to take a role in HPV vaccination communication
Model other evidence-based strategies to increase HPV vaccination coverage in your office.
Introduce >2 new practice tools into to help support HPV vaccination in the pediatric health care setting.

51. The End
Thank you for watching!