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

2. Making Effective HPV Vaccine
Recommendations

3. 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.     

4. 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 If you have any questions about this CE activity, contact Michelle Daugherty at or   
If there is no joint provider, you can put this slide later in the disclosures as appropriate.

5. 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.

6. 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

7. 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

8. Review evidence

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

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

11. Announce

12. Announce

13. 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
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14. HPV vaccine is safe
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15. Low HPV vaccine coverage in WA
Healthy People Target
up to date
National Immunization Survey – Teen, 2016
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16. Parents’ perceived importance of HPV vaccine
What parents said
HPV vaccine importance rating
Healy et al., 2014, Vaccine
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17. 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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18. Provider recommendations are uniquely powerful
National Immunization Survey – Teen, Lindley et al., 2016
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19. Provider recommendations are uniquely powerful
No recommendation
35%
National Immunization Survey – Teen, Lindley et al., 2016
Announce

20. Provider recommendations are uniquely powerful
With recommendation
65%
National Immunization Survey – Teen, Lindley et al., 2016
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21. Presumptive announcements work
Announcement approach training
A 5.4% increase in HPV vaccine initiation by 3 months.
Brewer, et al., 2017, Pediatrics
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22. Build skills

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

24. 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

25. 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.
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Announce

26. 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

27. 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
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Announce

28. Demonstration

29. 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.
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Announce

30. 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

31. 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

32. Practice

33. 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
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Announce

34. 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
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Announce

35. How’d it go?
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36. 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
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37. 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

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