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When it comes to healthcare, what really matters to patients? In 2015 two physicians, Leana Wen, MD, MSc, Commissioner of Health for the City of Baltimore, and Suhavi Tucker, MD, from Mount Sinai Hospital, took to the streets of Washington, DC to find out.

After interviewing people at coffee shops, senior citizen homes, metro stops, and community centers, what the researchers discovered surprised them. It turned out that rather than a doctor’s intelligence, training or even skills, at the top of the list of things participants wanted were a doctor who listens to them, a doctor who is caring and compassionate, and a doctor who explains well and is transparent and open.

According to the study, “the doctor/ patient relationship remains at the heart of people’s perceptions of healthcare.”

CU Cancer Center investigator, Amanda Dempsey, MD, PhD, MPH, puts this idea at the center of her research in cancer prevention. And she shows that as much as cancer prevention depends on actions like smoking cessation and vaccination, equally important is how we talk about these things. It turns out that in preventing cancer, communication is key.

HPV virus

HPV 101
Human Papillomaviruses (HPV) are not one, but approximately 200 different viruses. According to the National Cancer Institute, more than 40 types of these viruses can be spread from person to person through sexual contact, leading to HPV infection. Most of the time these infections are not cause for concern, however persistent infections from certain HPV viruses can lead to cell changes and ultimately cancer. In 2006 the Food and Drug Administration approved a vaccine to prevent these infections in girls. Shortly after in 2009 the vaccine was also approved for boys.
The vaccine is most effective at preventing infection if it is given before the patient is sexually active. Because of this it is recommended that patients start their vaccination series at ages 11 or 12, but it can be given as young as 9 years old.
The HPV vaccine works by stimulating the body to produce antibodies that help your immune system bind to and eliminate HPV virus. The vaccine is made from virus-like particles (VLP’s) that resemble the natural virus enough to encourage the body to create antibodies but lack viral DNA, and thus are not infectious.

THE PREDICAMENT OF THE HPV VACCINE

According to the Centers for Disease Control (CDC), in the United States the human papilloma virus causes 30,700 cancers in men and women each year. Worldwide, the number is closer to half a million. However, in the last decade since the CDC recommended the HPV vaccination, HPV-associated cancers have dropped 64 percent. Despite the proven effectiveness of the HPV vaccines only 60.4 percent of children aged 13 to 17 have started the vaccination series in the United States. If vaccination rates were higher the incidence of HPV would be even lower.

“The HPV vaccine has been around for over a decade yet there are low vaccination rates in the United States, especially compared to other countries,” explains Dempsey, associate professor of pediatrics at the CU School of Medicine. She’s not kidding: Thanks to an effort to distribute HPV vaccine for free at schools, Australia is on track to be the first country to completely eliminate cervical cancer.

Dempsey believes there are three major reasons for the United States’ low rate of HPV vaccination.

“First, past research shows that providers treat the HPV vaccine differently than other vaccination,” Dempsey explains. Specifically, studies have found that rather than treating the HPV vaccine like any other vaccination against disease, physicians feel the need to point out to parents that HPV is considered a sexually transmitted virus, possibly clouding parents’ perceptions of the vaccine by conjuring the taboo of teenage sexual activity.

“Second, media tends to treat the vaccine as controversial,” she says. A quick internet search proves her point: Many articles at alternative news sites claim harm from HPV vaccines, and even though FDA and CDC articles cite studies thoroughly debunking the safety myth, the fact that safety concerns are even mentioned may sour some patients on the need for vaccination.

“Finally,” Dempsey says, “people perceive it as a new vaccine despite the fact it has been around for years and millions of people have been vaccinated.” The perception that the vaccine is new can make it seem experimental or unproven, leading some parents to a wait-and-see attitude about vaccination. In other words, according to Dempsey, the overarching reason that people in the United States fail to get the HPV vaccination is lack of effective communication.

“I thought, if only we could help to improve communication between providers and their patients, we could increase vaccination rates,” she says. And so she designed a study to do just that.

A COMMUNICATION INTERVENTION

To figure out if helping doctors talk to their patients would have an effect on vaccination rates Dempsey and her team created a program made up of an HPV fact sheet library, a tailored parent education website, HPV-related disease images, an HPV decision aid, and two and half hours of communication training for healthcare providers. In total 16 primary care practices in Denver participated in the study, with 188 medical professionals who saw 43,132 adolescent patients. Half the practices would use Dempsey’s kit and the other half would continue with business as usual.

After the study concluded in 2015, there were obvious differences between “intervention” and “control” practices. The intervention practices saw an
11.3 percent increase in adolescents initiating the vaccine series while the control practices saw a 1.8 percent increase. Additionally, at intervention practices, teens who started the vaccination series were more likely to complete it.

Dempsey and her team are excited to see that something as simple as optimizing communication can have a substantial impact on vaccination rates. However, they also know that there is a long way to go to get vaccination rates to where they should be.

“Increasing vaccination rates is hard and takes lots of interventions,” says Dempsey. “This is not a magic bullet that will completely get rid of the problem, but it is a good start.”

NEXT STEPS

Now that Dempsey has shown that the communication intervention works, she is trying to get more primary care practices to use it.

“We know from surveys taken at the end of the study that the communication techniques and fact sheets were most commonly used by the providers,” she says. “Hopefully we can use this information to make a simplified version of the intervention and take it to practices all across the state.”

Intervention practices had such positive results from the study that over 90 percent of health care professionals at these clinics said they would continue to use the components in the future.

“We are not reinventing the wheel by any means,” says Dempsey. “We are taking what doctors already do (communicating with their patients) and making it better and more effective. A small amount of time and training can make a big difference.”