250 - Improving The Equity of Cervical Cancer Prevention Through Education and Vaccination

Publication Number: 3242.250

Angela C. Judd, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States; Marie Brunelli, New York Presbyterian Brooklyn Methodist, Brooklyn, NY, United States; Martin Dorciak, Weill Cornell Medicine, Brooklyn, NY, United States; Oksana Nulman, Weill Cornell Medicine, Brooklyn, NY, United States

Background: Cervical cancer is the most common gynecologic cancer and fourth most common female malignancy. In the United States, the incidence of cervical cancer yearly is 7.5 per 100,000 women and causes approximately 4,290 deaths. Cancer burden disproportionately affects populations without access to screening or treatment. Black and Latin patients are shown to have worse morbidity and mortality outcomes 1. HPV is the primary cause of cervical cancer 2. In 2016 the CDC recommended HPV vaccination for females and males age 9-26 years. Recent research shows improved vaccination uptake if personally by friends, parents, and doctors 3,4.
This project takes place at a pediatric clinic associated with a community hospital. The population is diverse and primarily covered by Medicaid. Cycle 1: retrospective data analysis demonstrated poor HPV vaccination uptake.

Objective: Primary: to improve knowledge and interest in human papillomavirus (HPV) vaccination with special attention towards improving equity.
Secondary: exploration of parental perspectives on HPV infection, cancer risks and the impact on vaccination interest.

Design/Methods: Subjects: parents and guardians of patients age 9-12 years presenting for preventative care appointment.
Cycle 2: survey given before the appointment.
Cycle 3: survey and HPV CDC information sheet in English and Spanish given before the appointment.
Cycle 4: survey and personal letter from clinic attendings recommending HPV vaccination given before the appointment.

Results: Parents are 41% more likely to be interested in HPV vaccination the day of appointment when provided with CDC information (p < 0.01) and 31% less likely to delay vaccination for future visits (p < 0.01%).
Parents with a high level of concern regarding cancer/infection risk exhibit 50% more interest in vaccination the day of appointment relative to lower concern levels for all cycles.
In cycle 3, 60% of respondents who reported Latino ethnicity expressed an interest in vaccination today vs 27% in cycle 2; 46% of respondents who reported Black race expressed an interest in vaccination today vs 20% in cycle 2.
Cycle 4 did not significantly change the number of respondents reporting interest in vaccination the day of appointment (53% vs 52%) nor reporting that they are interested in future vaccination (23% vs 20%)

Conclusion(s): Providing information supporting HPV vaccination increases interest and should be presented in the primary language to every parent/guardian when vaccination is recommended. The level of personalization, CDC information sheet versus letter, did not appear to have an independent impact on interest.

HPV Vaccination Uptake/Interest per Intervention Cycle
Cycle 1 displays percentage of reviewed charts that the patient received HPV vaccination (1) compared to did not receive vaccination (2). Cycle 2, 3 and 4 displays interest in vaccination today (1), in the future (2), unsure (3), never (4).

Impact of Specific Parental Concerns of Vaccination Interest
Displays how parental concern about child becoming infected (1 not concerned - 5 very concerned), developing cancer, and infecting another child impacts interest in vaccination today (1), in the future (2), unsure (3),
or never (4).