1. Making Effective HPV Vaccine Recommendations
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2. Disclosures Presenter COI Planners COI Funding for this training
[Insert]
Planners COI
Funding for this training
[Insert]
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3. Clinicians are uniquely influential
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4. 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
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5. Review evidence

6. HPV-related disease incidence
President’s Cancer Panel Annual Report (2014)
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7. 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
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8. HPV vaccination impact
Near-eradication of genital warts in Australia
HPV vaccination available for females
88%
BMJ (Ali et al., 2013)
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9. Announce

10. 9-valent vaccine
FDA approved Give the HPV vaccine you have in stock Advise parents: don’t delay protection
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11. Low HPV vaccine coverage in NC
Healthy People 2020 Target
*3 doses
National Immunization Survey – Teen, 2014
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12. 53,000 unnecessary new cervical cancer cases
Missed opportunities
HPV vaccine initiation, girls
53,000 unnecessary new cervical cancer cases
MMWR (CDC, 2012)
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13. Parents’ perceived importance of HPV vaccine
According to parents
Vaccine (Healy et al., 2014)
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14. Parents’ reasons for not getting HPV vaccine
Not knowing enough
Safety concerns/side effects
Not necessary
No provider recommendation
National Immunization Survey – Teen, (Stokley et al., 2014)
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15. Provider recommendation
55% 1%
AJPH (Reiter et al., 2013)
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16. Clinicians are uniquely influential
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17. Questions?
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18. Build skills

19. 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)
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20. 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

21. 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

22. 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

23. 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

24. 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

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

26. 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.”
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© Dr. Noel Brewer, 2015

27. 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

28. Questions?
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29. Demonstration

30. 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

31. 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
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© Dr. Noel Brewer, 2015

32. Questions?
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33. Practice

34. 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.
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35. 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”
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36. How’d it go?
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37. How will you use the strategy with your patients?
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38. HPV vaccination is a team effort
Align your communication Consider other activities
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39. Next steps for vaccine prescribers
Use the communication strategy
Commit to applying to your practice
Set a goal
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40. CME credit Complete yellow CME survey
Don’t forget your CME certificate of participation
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41. Thank you! © 2015 University of North Carolina. All Rights Reserved.
Developed by Dr. Noel Brewer