JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
INTRODUCTION
were mainly focused on the factors associated with strength of recommendation including the patient’s gender. The following questions were asked to gauge parents’ response to the providers’ recommendation and reasons for refusing the vaccine. The next series of questions focused on HPV associated oropharyngeal cancer and whether increased knowledge of the disease and its increasing incidence would influence providers’ recommendation of the vaccine. Lastly, we gathered demographic data about the pediatricians including the number of years in practice, work setting, percentage of Medicaid funded patients, and gender. Pediatricians were chosen due to the majority of the HPV vaccines being delivered by providers in this specialty. 10 Responses were received electronically or by return of the paper survey. All results were entered into Survey Monkey® to facilitate analysis. Eleven of the 18 questions were chosen for further examination via chi-square or Fisher exact test to determine statistical significance of correlations among specific question answers (i.e. length of practice, practice setting etc) with the knowledge about the vaccine, knowledge about HPV associated oropharyngeal cancer, and recommendation of the HPV vaccine for males. Statistical analysis was done using Stata 12.0.
The incidence of human papillomavirus (HPV) related oropharyngeal cancer (OPC) has increased by 225%over the past 30 years with HPV detection in OPC tumor specimens increasing 16% to 70%. 1 Males are diagnosed with the HPV-related OPC 5 times more often than women. 1,2 If current incidence trends continue, the annual incidence in the U.S. of HPV positive oropharyngeal cancer will surpass HPV related cervical cancer by 2020. 1 Several thousand U.S. adults are diagnosed with HPV positive OPC annually with an annual direct cost of over $300 million to the national healthcare system. 3,4 While the overall survival for HPV positive OPC is excellent, the lifelong morbidity of treatment remains significant for those patients afflicted with this disease. Currently, there are no markers that would allow early identification of at-risk persons, which makes primary prevention of HPV infection through vaccination essential to preventing HPV (+) OPC. In September 2010, the U.S. Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee and The Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices (ACIP) expanded the recommendations for the HPV vaccine to include boys. 5,6 Despite this recommendation and the potential benefits towomen andmen, current vaccination rates for U.S. adolescents remain abysmal. 7 This is especially true for males who had vaccination rates of 1.4% in 2010 and who are disproportionately more often diagnosed with HPV positive OPC. 1,2,7,8 HPV vaccination campaigns and research into HPV-related cancers have largely been limited to the impact on cervical cancer and the prevalence of infection in young women. Physicians are the most vital component in patient education, as they often hold the most trusted role on the health care team from a patient’s perspective. The focus of this investigation was to ascertain practice patterns among pediatricians in Louisiana with regards to HPV vaccine administration and their understanding of the role of HPV in the development of OPC, as well as to determine whether knowledge gaps exist which would identify need for further education.
RESULTS
We received 116 responses, which was a response rate of 15.9%. About half the respondents (44.6%) have practiced for more than 16 years and 35.4% practiced for less than 5 years. Many of the practitioners (40.9%) belong to a single specialty group and 34.5% practiced in an academic hospital or in a public clinic. The majority of the respondents (55.4%) indicated that Medicaid funds more than 40% of their patients. The majority (60.9%) of the respondents were females (Table 1). One hundred four (89.66%) reported that they routinely recommend/offer the HPV vaccine, 6 (5.17%) occasionally or only at caregiver request, and 6 (5.17%) do not offer the vaccine. Of those who do not offer the vaccine, four are pediatric surgeons and two work in pediatric ERs. These six respondents were removed from further analysis, as their practice does not include vaccinations of any kind. Almost all (96.4%) recommend HPV vaccine for bothboys andgirls. One person does not recommend it for boys. A significant percentage of respondents indicated that the strength of their recommendation for the vaccine depends on the age (36.4%) or gender of the patient (14.6%). The majority (81.8%) gave an equally strong recommendation for boys and girls. Almost one-third of the providers did indicate that the strength of the recommendation depends on the caregivers’ response when discussing HPV vaccine and transmission. The willingness of the parent to provide consent for vaccination was only “somewhat willing” the majority of the time (61%), with only 34% of the responders reporting caregivers being very willing to consent to HPV vaccination. The most common reason cited by the pediatricians that caregivers give when refusing vaccine was fear of the side effects/safety. The second most common reason was that the caregiver was uncertain about the potential
METHODS
An eighteen-question survey was constructed. After obtaining Institutional Review Board approval from LSU Health Shreveport, the survey was sent electronically (Survey Monkey®), and a duplicate by mail, to all 730 members of the Louisiana Chapter of the American Academy of Pediatrics. Respondents provided informed consent and were not compensated for participating in the survey. The questions were constructed based on a framework developed from national guidelines and existing literature. The initial questions were to determine if the provider routinely offered HPV vaccine, to what age group vaccine was offered, specifically gauging if the vaccine was offered to 11-12 year olds as recommended in national guidelines. 9 The next questions
38 J La State Med Soc VOL 169 MARCH/APRIL 2017
Made with FlippingBook Digital Publishing Software