Identifying barriers to HPV vaccination and cervical cancer counseling and prevention in a resident's clinic: a quality improvement initiative

Objectives: To identify barriers encountered amongst ObGYN residents regarding education, counseling and dissemination of HPV vaccination in a residents’ clinic; to implement a lecture series aimed at improving the overall fund of knowledge regarding cervical cancer education and prevention while fostering the increase of HPV vaccination efforts. Methods: An online questionnaire was sent to 40 ObGYN residents at the Detroit Medical Center/Wayne State University School of Medicine with the aim of identifying the overall fund of knowledge regarding HPV vaccination/administration and cervical cancer counseling and prevention in the residents’ continuity clinic. Residents were asked to anonymously and voluntarily rank, from most significant to least significant, 10 barriers preventing the administration of HPV vaccination to patients during clinic visits. Further, an average of the number of HPV vaccinations offered in clinic by each resident during their training was obtained. Survey responses were stratified by year in residency. Following collection of initial data, a lecture series was developed with the aim of targeting knowledge deficits identified in the survey while fostering increased patient education regarding HPV vaccination and cervical cancer prevention. A post survey was subsequently applied to assess the impact of the lecture series on residents’ acquired knowledge. Primary outcomes included 1) identifying the main barriers preventing HPV vaccination and cervical cancer prevention counseling in an ObGYN resident clinic; 2) detecting deficits in basic knowledge regarding HPV vaccination amongst residents. Qualitative and simple descriptive statistics comparing before and after attitudes and fund of knowledge of residents regarding HPV vaccination and counseling were used. Results: Overall, 22.4% of the residents stated being unaware that HPV vaccination was available at the ObGYN resident clinic; 21.4% did not consider offering HPV vaccine to patients who were not sexually active; 13.5% did not consider using a post-partum visit to educate patients regarding HPV vaccination and cervical cancer prevention; 8.6% did not consider offering HPV vaccine to a patient with abnormal pap smear results; 8.6% stated not offering vaccines other than influenza and Tdap in their practice. In addition, 67% of the participants stated ordering HPV vaccine less than 5 times during their training. Diminished basic fund of knowledge was also noted regarding price per dose (28%), and adequate number of doses to be delivered to patients above the age of 15 (46%). Following a lecture series, fund of knowledge was greatly increased amongst residents with correct responses noted above the 90% to all questions in the questionnaire. A discussion regarding barriers to HPV vaccination and cervical cancer prevention was also held to encourage collaboration regarding tools to correct the aforementioned barriers and promote growth. Conclusions: We identified that ObGYN residents can greatly benefit from ongoing training regarding HPV vaccination and counseling. Implementing further educational efforts regarding HPV vaccination and cervical cancer prevention is an urgent matter. Interventions, including developing a checklist to aid in the optimization of HPV vaccination efforts (ongoing in our institution) along with the development of a national residency curriculum in cervical cancer prevention and HPV vaccination may be needed to address barriers to optimal patient care and delivery.