What Impacts HPV Vaccination Recommendations? An Exploration of Medical Residents' Knowledge, Training, Barriers, and Practices.

BACKGROUND AND OBJECTIVES: Increasing human papillomavirus vaccination (HPVV) uptake is critical to the prevention of cervical cancer. Effective physician communication and clinical workflow policies have a significant impact on vaccination rates. However, resident training programs vary in the inclusion of training in effective HPVV practices. At Dell Medical School in Austin, Texas, HPVV rates at primary care residents' clinic sites vary. We examined HPVV-related knowledge, training, barriers, and practices among residents in pediatrics (Peds), family medicine (FM), obstetrics and gynecology (Ob/Gyn), and internal medicine (IM) with the aim of identifying interventional targets to improve vaccination rates.

METHODS: This was a mixed-method study including qualitative interviews and a survey. We interviewed a sample of residents from each specialty to assess their training experiences and how they discuss HPVV. We recorded, transcribed, and coded interviews for thematic analysis. All residents were offered the opportunity to complete an electronic survey to quantitatively evaluate knowledge and vaccine practices. We performed χ2 and Fisher exact analysis to compare results between disciplines.

RESULTS: HPVV-related knowledge was similar across all four specialties and between resident year. Peds residents reported always recommending the HPVV significantly more than FM and Ob/Gyn residents for 11-17-year-old females. Only Peds residents reported receiving evidence-based vaccine communication training. Among all residents, the primary HPVV barriers included forgetting to offer the vaccine and time constraints. When discussing the vaccine, many interviewed residents were not offering a confident recommendation to all eligible patients, and instead were using a risk-based approach to vaccination.

CONCLUSIONS: There were inconsistencies across programs related to how and where residents receive HPVV training. This may impact the frequency and strength of resident vaccine recommendations. To increase HPVV rates, residency programs should prioritize implementation of multimodal interventions, including opt-out workflows and education on how to give confident vaccine recommendations.