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Implementation barriers and considerations for recommending and administering the human papillomavirus (HPV) vaccination in oncology settings

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Abstract

Background

Survivors of childhood and adolescent cancer experience low human papillomavirus (HPV) vaccination rates—a crucial form of cancer prevention. Oncology provider recommendations may increase young survivors HPV vaccine intent, but HPV vaccination is not typically provided in the oncology setting. Thus, we explored the implementation barriers of providing the HPV vaccine in oncology.

Methods

We interviewed oncology providers in a variety of specialty areas about their perceptions of the HPV vaccine and to explore barriers to recommending and administering the vaccine in their clinics. Interviews were audio recorded, quality checked, and thematically analyzed. Emergent themes were then mapped onto the Capability, Opportunity, Motivation, and Behavior (COM-B) Model and the Theoretical Domains Framework.

Results

A total of N=24 oncology providers were interviewed. Most provided direct clinical care (87.5%) and most commonly specialized in pediatric oncology (20.8%), medical oncology (16.7%), bone marrow transplant (16.7%), and nurse coordination (16.7%). Two themes emerged within each COM-B domain. Capability: 1) educational barriers to HPV vaccination and 2) complicated post treatment HPV vaccination guidelines. Motivation: 1) perceived importance of HPV vaccine and 2) concern about blurred scope of practice. Opportunity: 1) hospital administration and time concern barriers and 2) clinical workflow integration concerns.

Conclusion

Implementing HPV vaccination in the oncology setting has the potential to increase HPV vaccination rates among young survivors. Multi-level barriers to providing the HPV vaccine in the oncology setting were identified by participants. Leveraging existing implementation strategies may be an effective way to mitigate provider identified barriers and increase vaccination rates.

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Acknowledgements

We would like to acknowledge Dr. Angela Stover for her mentorship and expertise in implementation science.

Funding

This work was supported by the Huntsman Cancer Foundation, and the National Cancer Institute of the National Institutes of Health under award numbers P30CA042014 and a supplement under R03CA216174 (Kirchhoff and Kepka, PIs). The Department of Dermatology at the University of Utah supported Dr. Wu’s time on this project. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA

    Austin R. Waters, Karely M. van Thiel Berghuijs, Yelena Wu, Deanna Kepka & Anne C. Kirchhoff

  2. Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Austin R. Waters

  3. Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA

    Charlene Weir & Heidi S. Kramer

  4. Department of Dermatology, University of Utah, Salt Lake City, UT, USA

    Yelena Wu

  5. University of Utah College of Nursing, Salt Lake City, UT, USA

    Deanna Kepka

  6. University of Utah Department of Pediatrics, Salt Lake City, UT, USA

    Anne C. Kirchhoff

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  1. Austin R. Waters
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Corresponding author

Correspondence to Austin R. Waters.

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Conflict of interest

Dr. Deanna Kepka has received a small portion of her salary from a grant that is provided and supported by the American Cancer Society, who received funding from Merck, for the purpose of the “Mission: HPV Cancer Free Quality Improvement Initiative.” The rest of the study authors report no conflicts of interest.

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Waters, A.R., Weir, C., Kramer, H.S. et al. Implementation barriers and considerations for recommending and administering the human papillomavirus (HPV) vaccination in oncology settings. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01391-4

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