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The HPV vaccine: What FNPs need to know

Date: September 6, 2017

Nurse practitioners are qualified to carry out many of the same duties as primary care physicians , including examining patients, making diagnoses and prescribing medications. In a fact sheet published by the American Association of Nurse Practitioners, family nurse practitioners (FNPs) are also educated to provide guidance to patients about preventative health measures. FNPs are well positioned to initiate conversations about health issues such as weight management, cancer screenings, nutrition and vaccinations.

It is especially critical for FNPs to educate parents about the benefits of vaccinations for their children. While a vast majority of parents vaccinate their children against illnesses such as polio and tetanus — the U.S. Centers for Disease Control and Prevention (CDC) reported that adherence to the polio vaccine is over 93 percent — far fewer are comfortable with having their children vaccinated against the human papillomavirus (HPV). A ubiquitous sexually transmitted infection, HPV has been associated with an increased risk of several forms of cancer.

Given the connection between HPV and certain malignancies, FNPs should use their preventative health expertise to initiate conversations with parents concerning the benefits of the HPV vaccine for children. While such conversations have the potential to be contentious, health providers can employ a number of strategies to facilitate more successful dialogue.

A closer look at HPV
The U.S. National Cancer Institute (NCI) published a fact sheet stating that HPV is an umbrella term that refers to a group of closely linked viruses. There are in excess of 200 HPV “types.” A notable number of HPV types are spread via intimate contact — specifically oral, vaginal and anal sex. Not all HPV strains are spread sexually: warts on the hand and feet, for example, are created by a form of non-sexual HPV.

The virus is incredibly common. A CDC fact sheet reported that as many as 80 million people across the U.S. are currently living with one or more types of HPV. The virus is so widespread that virtually all sexually active adults will contract one or more types of HPV in their lifetime. A vast majority of the time, HPV is asymptomatic in patients, and the body is able to kill the infection naturally. Most people are unaware when they contract the virus.

In some cases, so-called high-risk HPVs can lead to the development of certain forms of cancer, including cervical cancer, oropharyngeal cancer and anal cancer. The NCI fact sheet noted that HPV types 16 and 18 are strongly linked with the formation of cervical cancer in women, and a majority of cervical cancer cases — an estimated 70 percent — are caused specifically by one of these two HPV types. Close to 100 percent of all cervical cancer cases are caused by HPV in general. Type 16 is also closely connected with the development of anal cancer.

Why is the HPV vaccine important for preadolescents?
Several forms of the HPV vaccine currently are available and target the types of the virus most strongly connected with the development of cancer, Digital Content Director Elizabeth Mendes explained, writing for the American Cancer Society. The vaccines can also help safeguard against the development of genital warts.

The HPV vaccine is most effective when it is received during preadolescence, specifically around the ages of 11 or 12, according to an American Academy of Pediatrics (AAP) fact sheet. Mendes noted that the vaccine’s efficacy begins to wane if it is received after the age of 14. Primary care providers should administer two shots of the vaccine to children in this age range, a CDC fact sheet maintained. The shots should not be administered simultaneously. Rather, the first shot should be provided, with the second to follow six months to a year later. If the second shot is given before this minimum six-month window, a third shot may be needed to guarantee efficacy.

According to the AAP fact sheet, health care providers encourage parents to vaccinate their children against HPV at age 11 or 12. The mail reason being, children of this age have immune systems that are more receptive to the vaccine. Also, to work most effectively, the vaccine must be administered in its entirety before sexual activity and potential HPV exposure begins.

Why is the HPV vaccine adoption rate low?
Despite the vaccine’s benefits, the CDC reported that a notable number of young people are still not receiving the preventative measure. A CDC study found that, as of 2015, a majority of boys in adolescence — around six in 10 — had not yet received the shots. However, only a notable minority of girls — around four in 10 — had not received the immunization.

While HPV vaccine adoption rates are improving, they are still very low when compared with adherence to other kinds of vaccines, journalist Patti Neighmond pointed out, writing for National Public Radio (NPR). The reason for this low rate is thought to be two-fold.

There is likely some resistance from pediatricians and other primary care providers to initiate the conversation about the vaccine. As Neighmond explained, citing health and behavior scientist Noel Brewer, studies have shown that doctors do not enjoy discussing the issue of HPV and the preventative vaccine. Since HPV is connected with sexuality, primary care providers fear that parents may become embarrassed or upset when discussing a sexual issue in relation to their preadolescent children. Consequently, providers can be less assertive in terms of relaying the information.

When the vaccine is discussed, it is not uncommon for parents to resist the idea. Fact sheets from the CDC and AAP indicate that parents can sometimes worry that the HPV vaccine will be interpreted by their children as permission to begin sexual activity. The CDC noted, however, that research has debunked this common misconception — children who receive the vaccine are not more likely to begin sex earlier than their peers who do not receive the shots.

Strategies for talking to parents
Given that the HPV vaccine conversation has the potential to be difficult for parents, it is imperative that primary care providers, including FNPs, broach the topic with care and sensitivity. Some effective strategies for ensuring successful dialogue include the following:

    1. Placing an emphasis on cancer risk
    While it is true that HPV is contracted sexually, the vaccine’s objective is to reduce the risk of certain types of cancer. Primary care providers should make cancer risk the driving focus of the HPV vaccine conversation, said Dr. Ron Marino in an article published by the American Osteopathic Association. Instead of focusing on HPV transmission, primary care providers should lead the conversation by explaining the risk of malignancies such as cervical cancer and anal cancer. Marino elaborated on this point: “It’s not a time to talk about safe sex and condoms. The HPV vaccine helps keep patients from developing cervical cancer.”

    2. Giving a personal recommendation
    As advised in the CDC guidelines, it can be impactful for primary care providers to frame the advice in a more personal way. This approach means emphasizing a connection to the vaccine. Primary care providers could tell their patients that they gave the vaccine to their own children or other members of their family. If a familial connection is missing, primary care providers could stress that they would feel safe delivering the vaccine if they had children of their own.

    3. Mentioning both genders
    The HPV vaccine safeguards both genders against a range of cancers, including anal and penile cancer. Parents may have the misconception that the HPV vaccine is reserved exclusively for girls, given the strong link between HPV and cervical cancer. Primary care providers should, therefore, remind parents that the shot is recommended for both genders, Vicki Martinka Petersen explained in the American Osteopathic Association article.

    4. Likening the HPV vaccine to others
    Medscape conducted a conversation with Dr. Jay E. Berkelhamer, who explained that one of the best ways for primary care providers to promote the HPV vaccine is to liken it to other shots, describing them together in the same sentence. Berkelhamer gave an example of how this could sound in practice: “Your child is due for three shots today: meningococcal conjugate vaccine, HPV vaccine and Tdap vaccine.” By keeping the message direct and likening the HPV vaccine to others, providers help parents better understand that there really is no difference between the shots — all are needed to keep children safe.

The above tips are by no means a set formula for approaching the conversation — conversations between primary care providers and patients will surely vary. Rather, they are helpful ways that primary care providers, including FNPs, can begin to address the topic of the HPV vaccine with parents.

Consider Bradley University
If you want to work closely with patients, including counseling them about preventative health measures, such as the HPV vaccine, pursuing a career as an FNP could be an ideal move. To begin your journey to this rewarding profession, consider applying to Bradley University’s online Master of Science in Nursing – Family Nurse Practitioner program. Designed to be completed online, this flexible program is an ideal way to combine study with a full- or part-time career.

Sources
https://www.cancer.org/latest-news/changing-the-doctor-parent-hpv-conversation.html
https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.html
https://www.aap.org/en-us/Documents/hpvtoolkit_RI_Success_Resources_2015_Sept.pdf
http://www.npr.org/sections/health-shots/2016/12/05/504136418/when-doctors-talk-to-parents-about-hpv-vaccine-make-it-brief
https://www.cdc.gov/nchs/fastats/immunize.htm
http://thedo.osteopathic.org/2016/01/why-physicians-avoid-discussing-the-hpv-vaccine-with-young-patients/
https://www.cdc.gov/hpv/parents/vaccine.html
https://www.aanp.org/all-about-nps/what-is-an-np
https://www.cdc.gov/media/releases/2015/p0730-hpv.html
https://www.cdc.gov/hpv/parents/whatishpv.html
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet
http://www.medscape.org/viewarticle/827912_3
http://onlinedegrees.bradley.edu/nursing/msn-fnp/

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