With the recent approval of the first vaccine for human papillomavirus (HPV), this study takes a closer look at the implications for counseling about cervical cancer prevention in primary care.
It finds that the unique conditions of the preadolescent and young adolescent visit pose a challenge to the successful integration of HPV vaccine counseling.
In-depth interviews with 37 primary care clinicians in New Mexico, revealed four factors that influence physicians? counseling strategies with their adolescent patients: 1) the need to build rapport with adolescent patients, 2) the presumption that adolescent patients engage in high-risk behaviors, 3) the situational delivery and complexity of HPV counseling, and 4) perceptions of clinician and community receptivity to the HPV vaccine.
The authors point out that the greatest HPV counseling challenges stem from the fact that the vaccine is recommended to be given when girls are 11 to 12 years old and before the onset of sexual activity. In the interviews, clinicians indicated that STD, and HPV counseling in particular, are typically initiated during ?teachable moments,? such as when reporting an abnormal Pap smear result or finding genital warts; however, this is more likely to occur when the patient is much older than the age recommended for HPV vaccination. Moreover, younger adolescents are more likely to be accompanied by a parent to the visit, requiring involvement of the parent in these sensitive discussions.
They conclude it will be necessary to develop counseling strategies that emphasize a preventive focus, to include parents in the discussion at the time of vaccination, and to take into account the needs of people with different cultural values and beliefs.
HPV and Cervical Cancer Prevention Counseling with Younger Adolescents: Implications for Primary Care
By Andrew Sussman, Ph.D., M.C.R.P., et al