Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine

Fenton, Anny; Elliott, Marc N.; Schwebel, David C.; Berkowitz, Zahava; Liddon, Nicole; Tortolero, Susan R.; Cuccaro, Paula; Davies, Suzy L.; Schuster, Mark A.

doi:10.1016/j.socscimed.2017.09.030

Cited by 21 publications

(8 citation statements)

References 73 publications

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“…Clear decision-making tools that assist health care providers in identifying male patients that may benefit from HPV vaccination after age 26 are critical, given low levels of knowledge and awareness among mid-adult men limit their ability to initiate shared clinical decision-making conversations themselves. As complimentary evidence suggests some racial/ethnic minority patients are less likely to receive routine HPV vaccine recommendations from health care providers ( Fenton et al, 2018 ; Polonijo, 2020 ; Ylitalo et al, 2013 ), such guidelines could be leveraged to address these inequities.…”

Section: Discussionmentioning

confidence: 99%

“If People Were Told About the Cancer, They’d Want to Get Vaccinated”: Knowledge, Attitudes, and Beliefs About HPV Vaccination Among Mid-Adult Men

Alaraj¹,

Brown

Polonijo

2023

Am J Mens Health

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In 2018, nine-valent human papillomavirus (HPV) vaccine eligibility expanded to include adults aged 27 to 45. This study aimed to identify knowledge, attitudes, and beliefs (KABs) about HPV and HPV vaccination among newly eligible mid-adult men, for whom uptake in adolescence and younger adulthood remains suboptimal. We conducted six virtual focus groups ( N = 34 participants) with unvaccinated men aged 27 to 45 living in Southern California’s Inland Empire. Data were systematically analyzed to identify emergent themes using the rigorous and accelerated data reduction technique. The sample of men was diverse (79% Hispanic, non-Hispanic Black, Asian, or mixed race/ethnicity; 26% gay or bisexual) and captured participants from across the socioeconomic spectrum. Eighty-eight percent of participants had never received a provider recommendation to be vaccinated against HPV. Many had unanswered questions about HPV and HPV vaccination, could not recall any HPV-related cancers that affect men, and were unaware of their current eligibility for vaccination. Embarrassment and stigma surrounding vaccination against a sexually transmitted infection, concerns about vaccine side effects and safety, and preferences for preventing HPV via “safer sex” and monogamy were salient barriers to vaccination. Nevertheless, many men were eager to learn more about HPV vaccination and engage with health care providers around that topic. Interventions aimed at improving men’s knowledge, changing social norms, and supporting health providers to identify HPV vaccine-eligible patients may be especially fruitful for facilitating shared clinical decision-making between mid-adult men and their health care providers.

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Section: Discussionmentioning

confidence: 99%

“If People Were Told About the Cancer, They’d Want to Get Vaccinated”: Knowledge, Attitudes, and Beliefs About HPV Vaccination Among Mid-Adult Men

Alaraj¹,

Brown

Polonijo

2023

Am J Mens Health

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“…While it remains to be investigated whether patient-centered care can reduce patients’ distrust toward health care institutions, this approach has potential to at least reduce the negative effects of such distrust on patient-provider interactions. More studies focusing on the effectiveness of patient-centered care in real-world settings are needed (e.g., Federman et al, 2018; Fenton et al, 2018). In particular, studies should investigate the interplay between patients’ past experiences of discrimination and clinicians’ biases and how these factors together influence interactions, medical decision making, and health-related outcomes.…”

Section: Discussionmentioning

confidence: 99%

Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making?

Cuevas¹,

OʼBrien²,

Saha³

2019

Health Psychology

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Objective: Mistrust in medical institutions has been implicated as a barrier that disproportionately affects the quality of health care received by patients. Although patient-centered communication has been shown to improve patient-provider relationships, little is known as to whether it may reduce the effects of medical mistrust on patients' decision-making and trust in physicians (physician mistrust). Method: In a laboratory study, 231 primary care patients (101 African American and 130 White participants) were randomly assigned to one of two conditions in which they viewed video recorded, standardized vignettes depicting a cardiologist recommending coronary bypass surgery to a patient diagnosed with angina and 3-vessel coronary artery disease. In each vignette, the cardiologist-actor demonstrated either low or high patient-centered communication behavior. Participants were asked to assume the role of the patient interacting with the video-recorded physician. Results: Hypotheses were partially supported. High levels of medical mistrust were associated with greater physician mistrust and lesser endorsement of the hypothetical bypass surgery. Among patients exposed to high patient-centered communication, the relationships between medical mistrust and both physician mistrust and surgery endorsement were weaker than among patients exposed to low patient-centered communication. Although African American patients reported greater medical mistrust compared with White patients, respondents' race did not moderate the relationships. Conclusions: Results suggest that mistrust toward health care may unfavorably affect interactions and patients' health-related outcomes. Physicians may buffer the effects of mistrust by using patient-centered communication skills such as soliciting the patient's concerns and priorities and being responsive to the health care needs which patients identify

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“…Additionally, only 7% of parents and 12% of children had a racial-ethnic minority background. Studies indicate that providers are less likely to recommend the HPV vaccine to African American parents (Fenton, Elliott, et al 2018; Polonijo and Carpiano 2013). Therefore, medical professionals may discuss the vaccine differently with white parents.…”

Section: Discussionmentioning

confidence: 99%

Abandoning Medical Authority: When Medical Professionals Confront Stigmatized Adolescent Sex and the Human Papillomavirus (HPV) Vaccine

Fenton

2019

J Health Soc Behav

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Despite authority’s centrality to the medical profession, providers routinely forgo their medical authority during clinical encounters. Research focuses on patients challenging medical authority but indicates these confrontations are uncommon and providers seldom relinquish their authority in response. Using rare data of 75 audio recordings of adolescent vaccine discussions during clinical encounters and interviews with and observations of medical staff, I examine how staff leverage or abandon their medical authority to convince parents to vaccinate. I find medical professionals use less authority when at risk of stigmatizing patients: Medical professionals are less authoritative when recommending human papillomavirus (HPV) vaccination versus other adolescent vaccines, particularly when addressing the need to vaccinate before sexual onset due to concerns of labeling the child as sexually active. Medical staff defer to parents in ways that potentially discourage HPV vaccine uptake: They encourage HPV vaccination less than other vaccines and infrequently challenge parents’ sex-related reasons for vaccine refusal.

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Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine

Cited by 21 publications

References 73 publications

“If People Were Told About the Cancer, They’d Want to Get Vaccinated”: Knowledge, Attitudes, and Beliefs About HPV Vaccination Among Mid-Adult Men

“If People Were Told About the Cancer, They’d Want to Get Vaccinated”: Knowledge, Attitudes, and Beliefs About HPV Vaccination Among Mid-Adult Men

Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making?

Abandoning Medical Authority: When Medical Professionals Confront Stigmatized Adolescent Sex and the Human Papillomavirus (HPV) Vaccine

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