A Pilot Study Testing the Effect of a Decision Aid on Parental Decisional Conflict Related to Human Papillomavirus Vaccination

Abstract

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV is responsible for multiple disease states and cancers around the globe of varying severity in both females and males. Although a vaccine is available to protect against the strains of HPV most likely to cause significant health effects, vaccination rates are disappointingly low compared to other recommended vaccines. The primary aim of this study was to test the feasibility and acceptability of implementing a short primary care, office-based, decision aid for a parent/child dyad deciding whether to accept HPV vaccination. The secondary aim of this study was to gather preliminary data for (a) describing the frequency of decisional conflict in parents scheduled to obtain the recommended HPV vaccine for their child in a primary care pediatric practice, (b) testing the hypothesis that parental post-intervention decisional conflict will be less than parental pre-intervention decisional conflict; (c) testing the hypothesis that there will be a difference between the proportion of parents with decisional conflict who accept the HPV vaccine and the proportion of parents with no decisional conflict who accept the HPV vaccine; and (d) testing the hypotheses that factors affecting parental vaccine acceptance include the adolescent’s opinion regarding HPV vaccination, whether any children in the family have already received the HPV vaccine, and a personal or family history of HPV related disease, in addition to parental decisional conflict. An additional exploratory aim of this study was to gather preliminary data for describing the frequency of parental decisional regret two weeks post-vaccination decision. A single-arm prospective interventional pilot study was conducted using an interactive decision aid with 80 parent/child dyads considering HPV vaccine acceptance in a primary care pediatric office. Overall, participants found the decision aid to be acceptable (ease of use and time) and helpful. The majority of parents reported decisional conflict pre-intervention. Total decisional conflict as well as all subscale scores decreased post-intervention. As expected, using chi-square analysis, the proportion of parents with decisional conflict who accepted the HPV vaccine for their child was significantly lower than the proportion of parents with no decisional conflict who accepted the HPV vaccine. Using binary logistic regression, results indicate that three factors (having a child previously vaccinated against HPV, parental decisional conflict defined as a score of greater than 2.0 using the Decision Conflict Scale at the time of the vaccine decision and the adolescent’s opinion regarding HPV vaccination) were significant predictors of parental acceptance of the HPV vaccine for their child. While the majority of parents reported low to no decisional regret two weeks after the vaccination decision, two of the three parents expressing significant decisional regret declined the HPV vaccine for their child at the time of the health visit.