Study reveals variability in physician intentions and recommendations on HPV vaccination

Researchers at Moffitt Cancer Center surveyed 1,008 physicians seeking their knowledge, recommendation beliefs and information on their practices regarding the controversial human papillomavirus (HPV) vaccine, which is aimed at preventing cancers resulting from sexually transmitted HPV infection. Of the physicians surveyed, 112 provided additional comments at the conclusion of the survey.

"The physicians who responded in the free text space emphasized issues that were most important to them and offered insight on several aspects of the vaccine," said lead author Susan T. Vadaparampil, Ph.D., M.P.H., associate member of Health Outcomes & Behavior.

According to the researchers, HPV infection is the most common sexually transmitted infection. HPV infection has long been linked to cervical cancer but is also associated with oropharyngeal cancer. Because young, sexually active females ages 14 to 19 are at the greatest risk, the vaccine has been recommended for females ages 11 to 12 and potentially younger at a health care provider's discretion.

"Previous studies have shown that physician recommendation is a strong indicator of whether parents of young daughters will or will not support vaccination," explained Vadaparampil. "The study also reveals variability in physician intentions and recommendations regarding HPV vaccination. Intentions and whether to recommend the vaccine are influenced by a physician's personal knowledge, attitudes and beliefs."

Doctors who discussed their personal views of the vaccine in the free text comments expressed concerns about safety, efficacy, morality, receptiveness of parents, and "interference" by government and the media.

Opinions summarized by study co-author Gwendolyn P. Quinn, Ph.D., associate member at Moffitt and director of the Survey Methods Core Facility, show that many physicians who responded (whose practice areas comprised family medicine, pediatrics and obstetrics/gynecology) revealed a variety of concerns:

•The majority of physicians who had safety or efficacy concerns were not in favor of recommending or administering the vaccine.
•Some who had safety concerns still recommended the vaccine.
•The strongest objections to the vaccine came from those practicing family medicine; their objections were that with the vaccine, girls might forego screenings, that it was unnecessary for those younger than 13, and that the vaccine promoted promiscuity.
•Some physicians stated that many parents who objected to the vaccine were "in denial" about their daughters' sexual activity.
•Some doctors supported mandating the vaccine in hopes that a mandate would alleviate the "burden" of having to persuade parents to vaccinate.
•About half the respondents said the media fueled and exacerbated the HPV controversy.
•Some physicians expressed their overall support for the vaccine; some promoted its use for males and females older than 26.

"Those who responded with free text comments were most likely to comment on HPV vaccine aspects that included cost concerns, institutional policies and procedures and, of course, offered their personal views regarding HPV vaccine," explained Vadaparampil. "Most of those concerned with vaccine costs advocated for insurance reimbursement."

The researchers noted that only 11 percent of the survey respondents added free text comments, suggesting that the responding group may have stronger beliefs than others about the HPV vaccine. That group could also have the most experience with the vaccine, they said.

"HPV vaccination has the potential to reduce cancer-related morbidity and mortality," concluded Vadaparampil and her co-authors. "Providers play a key role in widespread vaccination, and this study provided additional insight into factors associated with physician recommendations."

For the researchers, a new area ripe for research emerged with the concern expressed by some physicians that once vaccinated, some might not seek regular screening.