TIP Talk!

Wednesday June 6, 2018

The Importance of a Doctor's Words in HPV Vaccination


An important new study conducted in Texas offers a hopeful message about overcoming parents’ objections to the human papilloma vaccine for their teenagers and preteens. It shows that doctors who take a persistent approach with vaccine-hesitant parents have much more success gaining their agreement to vaccinate their children against HPV.

HPV vaccination was a particularly crucial area of study because too many parents resist having their children immunized against a sexually transmitted disease. But studies have found that getting the vaccine doesn’t change adolescents’ sexual behavior. What it does do is protect against many forms of cancer, including HPV-related cancers of the cervix, mouth, throat, penis and anus. And the vaccine is more effective if given to younger patients, before the virus may have been transmitted.

Studies have repeatedly found it to be safe and effective. In fact, a study conducted in late May should lay to rest a persistent rumor about the vaccine, that it might result in autoimmune disorders in some young people. The study of more than 290,000 girls found no increased risk of such disorders.

Yet only about 60 percent of teenagers nationwide have had at least one dose of the HPV vaccine, the U.S. Centers for Disease Control and Protection reported last year. And in Texas, the numbers were distressingly lower: Only 49.3 percent.

So the state was the perfect place for this most recent study of how doctors’ responses to vaccine-hesitant parents might change vaccination rates. It was published in the June volume of the journal Pediatrics.

The researchers from University of Texas Southwestern Medical Center audio-recorded 43 visits to clinics in Dallas. Of those, 37 parents voiced some kind of hesitancy about the HPV vaccine. Most of them – 27 – strongly objected to it. Smaller numbers of parents had questions or concerns.

The study looked at three different ways doctors responded to those concerns: acquiescence, or simply going along with not vaccinating; persistence and acquiescence, or prodding the parents to vaccinate but adding that it was up to them; or persistence alone, simply telling parents that it was an important thing to do.

The persistent doctors weren’t just more successful. The difference was dramatic.

As reported by Forbes  magazine:

Parents expressed hesitation to allow their children to be vaccinated in 37 of these visits. When this was the case, and doctors did not challenge the parents, and acquiesced-- giving statements such as “maybe you will change your mind in the future”—the child was not immunized.

But when the doctor relied on both persistence and acquiescence --“if you don’t want that, it’s fine with me, but it’s for safety.”--15% of the patients received the vaccination. But when doctors just relied solely on persistence,- “when they get them when they are younger, their immune system builds up a better response,” 94% of the children received vaccinations.

Persistence alone, in fact, worked in 7 of 7 challenging subjects in the study, even in a situation where their parents were initially strongly opposed to vaccination.

The results are in keeping with a similar study last year. It found that doctors were far more successful in getting children vaccinated when they talked to parents in ways that assumed  it would happen, instead of asking the parents if they wanted it.

Saying, “Kyle is 11 now. At this age, we give him his Tdap and first HPV and meningococcal vaccine” worked better than saying, “Is it OK to give Kyle his HPV vaccine? I know it’s controversial but it’s really important.”

Repeated studies have shown the HPV vaccine to be remarkably effective; modern medicine has the key to preventing thousands of cancer cases each year, and potential deaths from those cancers.

The study was small, and its results would need to be replicated through further research. But this examination of doctors’ word choices offers promising evidence that doctors can be extremely influential in vaccination decisions, if they know what to say. Yet a study in March found that doctors were much less likely to even offer  the vaccine to boys than to girls.

Perhaps regular training sessions for doctors, especially pediatricians, on vaccine persuasion could protect a new generation from the risk of these types of cancer. Imagine if all physicians knew how best to reach out to vaccine-resistant parents, and how much their words matter.



TIP Op-Ed Answers Parents' HPV Questions 

Oropharyngeal Cancer is a Growing HPV Concern 

 Parent Education Leads to Better Vaccine Decisions



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