Normalizing preteen HPV vaccination with practice-based communication strategies

Principal Investigator: Bernard Fuemmeler, Ph.D.

Funding Source: NIH / UNC

Project Summary:

Despite growing evidence of its effectiveness in protecting against sexually transmitted infection (STI) and certain cancers, vaccination against human papillomavirus (HPV) in the United States has stalled. HPV vaccination completion among females was actually lower in 2012 than in 2011. HPV is the most common STI in the US, causes genital warts, and is associated with cervical, vaginal, vulvar, anal, penile, and throat cancers. HPV vaccine is most effective when given before exposure to the virus, and is recommended for routine administration to 11-12 year old females and males. Health care providers play the primary influential role in parents' decisions to vaccinate, yet too often provie weak recommendations for HPV vaccination. Many parents think their preteens are too young for HPV vaccination and teens are not routinely included in the decision to vaccinate. Missed opportunities to vaccinate against HPV at the same clinical visit with other preteen vaccines are far too frequent. Among unvaccinated girls in 2012, 84% had a health-care encounter where they received another adolescent age vaccine but not HPV vaccine. This research aims to eliminate this gap by transforming clinical care through an improved communication system and ultimately normalizing HPV vaccination at the optimal ages of 11-12. Principles of dissemination (conscious effort to spread an evidence- based innovation, the HPV vaccine) and implementation (adoption of an innovation in specific settings) science are used. The multiple baseline design will include an intervention with communication strategies adapted to rolling groups of practices (n=48) that (1) report to the North Carolina Immunization Registry (NCIR); and (2) agree to use mobile devices and web-based modalities to keep up to date on HPV vaccine and to educate parents and preteens about HPV vaccination. The overall objective is to assess the extent to which providers, parents and preteens respond to these proactive communication strategies by vaccinating preteen girls and boys. The long term goal is to prevent HPV-related disease through early intervention and protection against this STI. The central hypothesis is that providers, parents and preteens are relevant decision makers who can be motivated to complete the HPV vaccination series according to public health recommendations. The aims are to (1) Develop new and adapt existing theory-driven dissemination and implementation strategies to motivate providers, parents and preteens to initiate and complete the HPV vaccine series; (2) Evaluate theory driven dissemination and implementation strategies to stimulate communication among providers, parents and preteens to motivate HPV vaccination and completion of the series; and (3) Determine practice characteristics related to adoption, implementation, and maintenance of these dissemination and implementation strategies to motivate HPV vaccination of preteens. The positive impact is that effective HPV vaccination dissemination and implementation strategies will be available for use in practices to reduce HPV infection and related diseases.

Advantages, Disadvantages and Consequences of OpenNotes in Cancer Settings

Principal Investigator: Richard Brown, Ph.D.

Co-Principal Investigator: Jordan Alpert, Ph.D.

Funding Source: National Cancer Institute R25 CA093423

Cancer patients in the VCU health system (VCUHS) are now able to access their electronic medical record through a patient portal. This initiative is called OpenNotes and enables patients to access information, such as scans, x-rays and radiology reports, often before seeing their oncologist. OpenNotes has been positively received in primary care settings, but its impact has not yet been explored in cancer settings. In this study we are exploring how this unfettered access to complex information may be positively and negatively impacting physician – patient communication. This formative research will explore patient, clinician and OpenNotes advocate views about, and experiences of patient access to medical data before oncologist consultations. Semi-structured Interviews will be conducted along with analysis of oncologists’ notes, comparing written messages before and after OpenNotes was adopted in the VCUHS.

Communication Strategies during Fertility Preservation Discussions

Principal Investigator: Richard Brown, Ph.D.

Co-Principal Investigator: Jordan Alpert, Ph.D.

Funding Source: National Cancer Institute R25 CA093423

Although the American Society of Clinical Oncology recommends discussions of fertility preservation between patients and providers prior to treatment, evidence suggests that fertility risks are not effectively communicated. This study will explore how conversations between patients and oncologists transpire, discover the type of information sought and identify communicative behaviors that occur during consultations. To achieve this, discussions among oncologists and patients will be audio recorded and subsequently analyzed. 

African American Cancer Clinical Trial Decisions: Testing Tailored Messages

Principal Investigator: Richard Brown, Ph.D.

Funding Source: American Cancer Society Research Scholar Grant

The purpose of this study is to demonstrate the efficacy of an established method, tailored health messaging, to aid African American (AA) cancer patients’ decision-making about joining a therapeutic clinical trial. This study moves the field forward as it is the first to utilize tailored heath messages to directly intervene in the physician – AA patient clinical trial consultation communication process to increase patient activation in the consultation and thus, potentially improve a range of relevant patient outcomes associated with AA barriers to accrual. We propose to conduct a randomized controlled trial to assess the differential impact on consultation communication of two different levels of tailored messages, (deep vs shallow tailoring) and the additional impact of either providing or not providing the patient’s oncologist with a summary of the tailored messages prior to the trial consultation.


Communication and Communication Outcomes for Cancer Survivors

Principal Investigator: Maria Thomson, Ph.D.

Funding Source: National Institutes of Health/National Cancer Institute 

This study will examine whether families and patients with blood cancers communicate well with each other about treatment and care decisions. These cancers can disrupt patient and caregivers’ lives and can cause patients and caregivers stress and make it difficult from them to continue to work or meet their family obligations. This study will examine whether and how their communication is associated with these outcomes and how we can intervene in the future to improve their quality of life and is important because a growing number of people are affected by these diseases, many of whom are working age adults. 

Oral Health Disparities, Community Engagement Plan

Principal Investigator: Maghboeba Mosavel, Ph.D.

Funding Source: DentaQuest Foundation/Fiscal Agent Pathways

The DentaQuest Foundation funded the Petersburg Wellness Consortium (Team Lead: Dr. Mosavel) to explore the oral health landscape in Petersburg using various community engaged research strategies. The Foundation’s current campaign – Oral Health 2020 – is mobilizing a national network across the grassroots, grassmiddles and grasstops to increase awareness of health equity and racial justice in the understanding of oral health disparities.  The PWC and VCU will conduct community engaged research to assess how 1) oral health can be integrated into education and other services, 2) to optimize oral health literacy, 3) to build a strong community prevention and care infrastructure. Laypersons will be engaged in all aspects of the research.