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Adolescent-Parent Dyad Descriptions of the Decision to Start the HPV Vaccine Series
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Poster Abstracts / 60 (2017) S83eS126
provider alert in the EHR (n¼139; age 9.8 years 0.6; 40% female), and another without the alert (n¼176; age 9.9 years0.9; 47% female). The latter group consisted of patients whose visit was likely scheduled after the early April schedule had been generated for the creation of the EHR alert. Each of these two groups were compared with eligible patients seen in March (pre-intervention, n¼319; age 9.9 years0.9; 42% female). The first dose of the HPV vaccine series was given to 22% of the April patients with the EHR alert; significantly higher than the vaccine initiation rate in patients without the EHR alert seen in the same month (7.4%; p¼0.0002) or in the month prior (6.6%; p<0.0001). The HPV vaccine initiation rate was not significantly different between the March group (pre-intervention) and the April group without the EHR alert (p¼0.74). Conclusions: Creating a provider alert in the EHR significantly increased the initiation of the HPV vaccine series in eligible patients younger than 11 years old. Future studies are needed to improve the intervention methodology for further increases in HPV vaccine initiation rate, and to determine whether this intervention increases rate of completion of the 3-dose HPV vaccine series prior to sexual initiation or HPV exposure. Sources of Support: None 234. ADOLESCENT-PARENT DYAD DESCRIPTIONS OF THE DECISION TO START THE HPV VACCINE SERIES Jane Chang, MD 1, Lisa S. Ipp, MD 1, Ariel M. de Roche, BS 2, Marina Catallozzi, MD, FSAHM 2, Carmen Radecki Breitkopf, PhD 3, Susan L. Rosenthal, PhD 2. 1
New York Presbyterian Hospital/Weill Cornell Medical College; Columbia University College of Physicians and Surgeons; 3Mayo Clinic College of Medicine.
2
Purpose: There is some evidence that adolescents and parents view their individual role in HPV vaccine decision-making differently. It is known that a strong provider recommendation is critical for HPV vaccine uptake; however, how adolescents and parents view the provider role may be less understood. Thus, we sought to examine how adolescent-parent dyads describe decision-making regarding initiation of the HPV vaccine series, specifically who they viewed as making the final decision and their description of the role of the provider.
Methods: Adolescent (ages 14-17 years)-parent dyads participating in a study on attitudes about participation in clinical trials were individually asked if the adolescent was offered the HPV vaccine series and if yes, had they started the series. Those who were offered the vaccine were asked: “How did you make a decision about whether or not to receive the HPV vaccine series?” Responses from the dyads in which both the adolescent and parent agreed that they started the series were included in this analysis. Responses were coded using content analysis. Results: There were 109 dyads (total sample ¼ 262 dyads) in which both the adolescent and parent agreed that the HPV vaccine series had been started. These adolescents were 63% female, 72% Hispanic, and had a mean age of 15.7 (SD ¼ 1.1); parents were 95% female. There was a range of descriptions of decision-making from only one person making the decision, someone making the decision with consultation from the other, to joint decision-making. Occasionally, adolescents and parents described completely different scenarios. For example, one adolescent said, “I got it in school. I had to do it. I didn’t discuss it with my parent,” and her parent said, “I discussed it with her doctor, and then briefly discussed with my daughter. She agreed to it.” More often a discrepancy reflected a different opinion about who had the final say. In 87 dyads, one or both of the participants spontaneously mentioned the medical provider. Sometimes it was not clear if the provider had made a strong recommendation. In other instances, the provider was clearly described as being involved in the decision-making or making a strong recommendation. In one instance, both adolescent and parent reported the adolescent was vaccinated despite vaccine refusal. Conclusions: There was a range in the descriptions of the relative contribution of the adolescent, parent, and provider in the decision-making process among adolescent-parent dyads who agreed the adolescent had started the HPV vaccine series. Although the two members of the dyad did not necessarily agree on the process, they agreed on the outcome which in this sample was starting the HPV vaccine series. Understanding the range of descriptions of these dyads is helpful to guide interventions to promote vaccine uptake in a manner that balances provider expertise, adolescent autonomy, and parental involvement. Sources of Support: NIH R01HD067287, UL1 TR000040, UL1 TR000457.
Poster Abstracts / 60 (2017) S83eS126
provider alert in the EHR (n¼139; age 9.8 years 0.6; 40% female), and another without the alert (n¼176; age 9.9 years0.9; 47% female). The latter group consisted of patients whose visit was likely scheduled after the early April schedule had been generated for the creation of the EHR alert. Each of these two groups were compared with eligible patients seen in March (pre-intervention, n¼319; age 9.9 years0.9; 42% female). The first dose of the HPV vaccine series was given to 22% of the April patients with the EHR alert; significantly higher than the vaccine initiation rate in patients without the EHR alert seen in the same month (7.4%; p¼0.0002) or in the month prior (6.6%; p<0.0001). The HPV vaccine initiation rate was not significantly different between the March group (pre-intervention) and the April group without the EHR alert (p¼0.74). Conclusions: Creating a provider alert in the EHR significantly increased the initiation of the HPV vaccine series in eligible patients younger than 11 years old. Future studies are needed to improve the intervention methodology for further increases in HPV vaccine initiation rate, and to determine whether this intervention increases rate of completion of the 3-dose HPV vaccine series prior to sexual initiation or HPV exposure. Sources of Support: None 234. ADOLESCENT-PARENT DYAD DESCRIPTIONS OF THE DECISION TO START THE HPV VACCINE SERIES Jane Chang, MD 1, Lisa S. Ipp, MD 1, Ariel M. de Roche, BS 2, Marina Catallozzi, MD, FSAHM 2, Carmen Radecki Breitkopf, PhD 3, Susan L. Rosenthal, PhD 2. 1
New York Presbyterian Hospital/Weill Cornell Medical College; Columbia University College of Physicians and Surgeons; 3Mayo Clinic College of Medicine.
2
Purpose: There is some evidence that adolescents and parents view their individual role in HPV vaccine decision-making differently. It is known that a strong provider recommendation is critical for HPV vaccine uptake; however, how adolescents and parents view the provider role may be less understood. Thus, we sought to examine how adolescent-parent dyads describe decision-making regarding initiation of the HPV vaccine series, specifically who they viewed as making the final decision and their description of the role of the provider.
Methods: Adolescent (ages 14-17 years)-parent dyads participating in a study on attitudes about participation in clinical trials were individually asked if the adolescent was offered the HPV vaccine series and if yes, had they started the series. Those who were offered the vaccine were asked: “How did you make a decision about whether or not to receive the HPV vaccine series?” Responses from the dyads in which both the adolescent and parent agreed that they started the series were included in this analysis. Responses were coded using content analysis. Results: There were 109 dyads (total sample ¼ 262 dyads) in which both the adolescent and parent agreed that the HPV vaccine series had been started. These adolescents were 63% female, 72% Hispanic, and had a mean age of 15.7 (SD ¼ 1.1); parents were 95% female. There was a range of descriptions of decision-making from only one person making the decision, someone making the decision with consultation from the other, to joint decision-making. Occasionally, adolescents and parents described completely different scenarios. For example, one adolescent said, “I got it in school. I had to do it. I didn’t discuss it with my parent,” and her parent said, “I discussed it with her doctor, and then briefly discussed with my daughter. She agreed to it.” More often a discrepancy reflected a different opinion about who had the final say. In 87 dyads, one or both of the participants spontaneously mentioned the medical provider. Sometimes it was not clear if the provider had made a strong recommendation. In other instances, the provider was clearly described as being involved in the decision-making or making a strong recommendation. In one instance, both adolescent and parent reported the adolescent was vaccinated despite vaccine refusal. Conclusions: There was a range in the descriptions of the relative contribution of the adolescent, parent, and provider in the decision-making process among adolescent-parent dyads who agreed the adolescent had started the HPV vaccine series. Although the two members of the dyad did not necessarily agree on the process, they agreed on the outcome which in this sample was starting the HPV vaccine series. Understanding the range of descriptions of these dyads is helpful to guide interventions to promote vaccine uptake in a manner that balances provider expertise, adolescent autonomy, and parental involvement. Sources of Support: NIH R01HD067287, UL1 TR000040, UL1 TR000457.