Educate and Advocate: Dental Providers Promote Human Papillomavirus Vaccination as Cancer Prevention in Interprofessional Community Health Clinic Pilot
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and the oropharynx is the most common site of HPV-associated cancer. The FDA’s approval for the nonavalent HPV vaccine expanded in 2020 to include prevention of oral cancers. Oral health practitioners (OHPs) are uniquely situated to recommend HPV vaccination as a primary preventive measure for oropharyngeal cancer (OPC). The aim of the project was to equip dental providers to educate patients about HPV and its link to OPC and to make a strong recommendation for vaccination. Patients could attain vaccination, as soon as same-day, following the dentist’s recommendation.
METHODS Following a synchronous training, OHPs at two community health clinics, one urban and one rural, in North Carolina educated patients about the HPV-OPC link and recommended HPV vaccination to patients ages 12-26-years during a 3-month quality improvement (QI) pilot intervention. An interprofessional dental-medical team enabled patients to attain HPV vaccination immediately after an OHP’s recommendation. Descriptive statistics were used to capture practice change.
RESULTS Patients ages 12-26-years accounted for 15.6% (323/2,066) of the appointments scheduled at two dental clinics staffed by five dentists. Prior to the pilot, 66.7% (6/9) of dental providers never educated patients about the HPV-OPC link and 88.9% (8/9) never recommended HPV vaccination. At the rural clinic, 25.5% (52/204) of 12-26-year-olds were overdue for HPV vaccination, OHPs educated and recommended vaccination to 59.0% of the targeted group, and seven patients were vaccinated during the pilot. At the urban clinic 44.5% of patients (53/119) were overdue for vaccination, 97.0% of targeted patients received the intervention, and three patients actualized same-day vaccination.
CONCLUSIONS The QI pilot equipped OHPs with the knowledge and confidence to educate patients about the HPV-OPC link and recommend HPV vaccination. These recommendations were associated with vaccine uptake.
REFLECTIONS Success of the pilot was facilitated by strong interprofessional collaboration including pre-existing systems to deliver vaccines at little or no cost to adolescents. The prohibitive vaccine cost ($248/dose) prevented willing 19-26-year-old uninsured patients from actualizing vaccination. Successful implementation of the practice change at two pilot sites suggests that dental providers in more settings should promote HPV vaccination as a cancer-prevention intervention.
PRIORITY CRITERIA Project highlights patient-centered perspective in actualizing the intervention (cost of vaccine, availability of Spanish-language education materials, insurance status), measures health outcomes (patients educated and vaccinated during intervention), and doctoral student is presenter.
