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HPV Vaccine: Avoiding Conversation Pitfalls with Families

Sean O'Leary, MD, FAAP
February 20, 2019

It’s Friday afternoon, and you have one last patient to see before heading out of the office for a weekend away. It’s an 11 year well-child check for a girl from a family you’ve seen for many years. No problem, right?

You have a nice visit with them. The girl is doing well in school, and they have no specific concerns. You finish the physical exam, go over anticipatory guidance, and begin to order the screenings and procedures called for at this visit.

“She’s due for three shots today,” you tell them, “her tetanus and whooping cough shot, her HPV vaccine which is to prevent cancer, and her meningitis shot. I’ll send our nurse in to get those taken care of.”

Not so fast.

“Well, we’re okay with that tetanus one, and the meningitis one,” they say, “but we’re going to hold off on that HPV vaccine.”

Sound familiar?

In #AAPvoices, Dr. Sean O’Leary on avoiding common pitfalls when discussing the #HPV vaccine with parents. #AAPvoices #VaccinesWork #PreventCancer

Since its introduction more than a dozen years ago, the HPV vaccine’s safety and effectiveness have been studied extensively--perhaps more extensively than any other single vaccine. The results of these studies are clear: the HPV vaccine is incredibly safe and effective. It is almost unique among vaccines in that the immunity established through vaccination is far superior to the immunity acquired by natural infection.

The public health urgency for increasing uptake of this vaccine is also quite clear: for every year rates remain low, many thousands of Americans will develop HPV-related cancers and many of these will people will die. Based on the latest federal statistics, there are about 42,700 HPV-related cancers each year: more than 24,400 among women, and upwards of 18,000 among men. The vast majority of these deaths are preventable with the simplest of interventions – a vaccine.

Despite all of this, the HPV vaccine discussion may represent a difficult encounter for many pediatricians. Most pediatricians now strongly recommend HPV vaccine to their 11- to 12-year-old patients, yet our immunization rates remain unacceptably low. How do you handle it when parents resist or refuse the HPV vaccine? How do you convey the vaccine’s importance?

"Approached in the right way, a 3-minute conversation may be all that HPV vaccine-hesitant parents needs to help make a decision that could save their child's life.”

At that Friday afternoon well-child visit, I followed the “same way, same day” approach. I told them their child is due for some vaccines, mentioned HPV the same way as the others, and assumed the family would want to proceed unless they have questions. With this evidence-based approach, the majority of families do accept the vaccine. But about one-third of families may still be hesitant.

To guide doctors in how to navigate those conversations, AAP has developed a new resource in collaboration with the Academic Pediatric Association and Kognito. The “Same Way Same Day” app helps providers learn and practice evidence-based communication techniques for recommending HPV vaccine to their patients.

Based on principles of adult learning theory, the app shows users when to switch to evidence-based motivational interviewing techniques to help parents feel heard and reduce their defensiveness. For example:

  • Ask open-ended questions. “What concerns do you have?” you might ask. In the app simulation, a mother describes reading a post in a parenting blog from a parent who said her child developed migraines after getting the HPV shot and ended up missing a year of school.
  • Acknowledge their concerns from their perspective, creating a respectful environment to continue the conversation. “That sounds awful. I can see why you might be worried.”
  • Affirm their good intentions. “It’s your job to protect your child.  I can see you care deeply about keeping her safe.”
  • Ask permission to share your perspective. “I’ve spent a lot of time looking into this.  Is it OK if I share my thoughts?” Research shows that this approach helps parents be more receptive to information that runs counters what they may have heard previously.

Approached in the right way, a 3-minute conversation may be all that HPV vaccine-hesitant parents need to help make a decision that could save their child’s life.

Remember, it’s not just way you say that matters – it’s how you say it.

* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Sean O’Leary, MD, MPH, FAAP, is a pediatrician and pediatric infectious diseases specialist at the University of Colorado School of Medicine and Children’s Hospital Colorado and an investigator at ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science). He serves on the AAP’s Committee on Infectious Diseases (the Red Book Committee) and is a liaison to the Advisory Committee on Immunization Practices (ACIP) for the Pediatric Infectious Diseases Society.


Follow him at @SeanOLearyMD (he’s kind of new to Twitter, so be nice).


Disclosure: Dr. O’Leary was part of the team that developed the Same Way Same Day app. He receives no financial compensation for downloads or use of the app. He has no other financial disclosures and receives no funding of any kind from pharmaceutical companies or vaccine manufacturers.

Additional Information

"HPV: Same Way, Same Day" app: available for download free from Apple's iTunes store and Google Play.

HPV Champion Toolkit