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Background: Human papillomavirus (HPV), the most common sexually transmitted infection in the United States, results in significant morbidity and mortality. Pediatric and adolescent cancer survivors’ vulnerability to second malignancies leaves this under-immunized population at increased risk. Methods: Guided by the Health Belief Model (HBM) and using quality improvement methodology, a HPV Cancer Prevention video was created and implemented during a routine survivorship appointment. The purpose was to 1) explore feasibility of a video implementation process, 2) improve provider recommendation/endorsement of HPV vaccine, 3) explore satisfaction, knowledge gain, and rationale for immunization and 4) measure initiation and completion rates. Results: The HPV Cancer Prevention video supplemented provider education and endorsement, successfully increasing HPV initiation and completion rates in a vulnerable survivorship population. Eighty percent of survivors and 73% of parents either strongly agreed or agreed that the video provided them with new information about HPV. Satisfaction rates for receiving HPV information in video format were similarly high, with 90% of survivors and 87% of parents satisfied, or very satisfied. Provider endorsement of immunization, a strong predictor of immunization, improved over historical baseline to 95% of the population. Immunization initiation and completion rates of 68% and 40.4% (respectively) were higher in this cohort of 59 survivors (33 males, 26 females) than for other cancer survivor populations. The most commonly reported rationale for uptake related to perceived susceptibility, reported as “cancer prevention”; cues to action such as provider recommendations and familial experience with HPV associated cancers were important; lack of perceived susceptibility featured themes about the lack of sexual activity. Other rationale included lack of research about the vaccine and religious justification. The decline to vaccinate rate was 32%. Conclusions: Capitalizing on oncology survivorship visits provides additional opportunities for discussion about HPV, and for immunization. Video education, a useful supplement to provider endorsement, and a feasible strategy for increasing uptake, requires an HPV champion for sustainability. Strategies to increase cancer survivors’ lower HPV immunization completion rates are necessary. Cancer survivor refusal rates are concerning in a population at heightened risk, and require further study. |
