SAN DIEGO – Among U.S. resident trainees in the primary care specialties, ob.gyn. and internal medicine resident physicians are the clear laggards when it comes to counseling appropriate candidates to receive the human papillomavirus (HPV) vaccine, Dr. Tiffany Zigras reported at the annual meeting of the Society of Gynecologic Oncology.
Pediatric residents led the way in self-reported “always” counseling eligible patients to receive the three-dose HPV vaccine series in her national survey, with family medicine residents in firm command of second place.
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Although the HPV vaccine was approved by the Food and Drug Administration in 2006, uptake remains low. A 2014 report based upon National Health Interview Survey data concluded only 13.6% of U.S. women ages 18-26 had received all three doses of the vaccine. A national Status of Cancer report concluded that only 32% of females ages 13-17 years had been vaccinated; in the uninsured population this rate fell to a mere 14.1% (Am J Public Health. 2014 May;104(5):946-53), noted Dr. Zigras of Bridgeport (Conn.) Hospital/Yale New Haven Health.
Since physician recommendation is known to play a key role in vaccine uptake and the approach taken by primary care residents hadn’t previously been studied, Dr. Zigras and her coinvestigators created a 37-item electronic survey and sent it to residency program directors in the various primary care disciplines with a request that they share the web link with their trainees.
The survey was completed by 1,549 resident physicians. Fully 82% of the pediatric residents indicated that they “always” recommend the HPV vaccine as an important means of cancer prevention. So did 64% of family medicine residents, 39% of ob.gyn. residents, and 28% of internal medicine residents.
Overall, female primary care residents were three times more likely than their male counterparts to always recommend the HPV vaccine to their eligible patients.
Primary care residents cited parental disapproval as a major reason for vaccine refusal in 49% of cases, fear of vaccines in general as an insurmountable issue in 34%, and fear of needles as a significant factor in 14%.
Whether or not respondent residents had received education about the vaccine during medical school had no bearing on their current self-described rate of HPV vaccine recommendation. However, residents who reported receiving education about the risks, benefits, and value of the vaccine during their residency training were significantly more likely to always recommend it for eligible patients.
“Residents have a unique opportunity to capture a subset of patients who may otherwise not have an opportunity to receive the HPV vaccine,” Dr. Zigras observed. “Education about the HPV vaccine in resident curriculum is critical to improve the uptake of the HPV vaccine in the United States.”
She reported no financial conflicts with regard to her study.