||5R01CA254931-02 Interpret this number
||University Of Colorado Denver
||Pcom2 - the Physician Communication Intervention, Version 2.0
Human Papillomaviruses (HPV) infect >90% of the population and cause >30,000 cervical, anogenital, and
oropharyngeal cancers annually. HPV vaccines have been available in the US since 2006 but only 54% of 11-
12 years-olds are vaccinated - well below national goals of 80%. As the title of the PAR to which this applica-
tion responds suggests (PAR-19-360), “Linking the Provider Recommendation to Adolescent HPV Vaccine Up-
take” is a key strategy for increasing adolescent HPV vaccination. Many studies show that a primary driver of
low adolescent HPV vaccination is a poor quality HPV vaccine recommendation from providers. While many
interventions to address this have been developed, few have been found in rigorous trials to increase vaccina-
tion and also be feasible to implement in busy clinical settings. An exception is the Physician Communication,
or PCOM, intervention developed by our group. PCOM focuses on teaching providers to use a 2-step verbal
communication process for their recommendation:1) start the vaccine discussion using a “presumptive” format
(i.e. “Let's get the HPV vaccine done today”) and 2) use motivational interviewing (MI) techniques to address
parental vaccine hesitancy, if needed. In a large, cluster-randomized trial, PCOM increased adolescent HPV
vaccine initiation rates among 11-12 year olds by 8 percentage points (PP) more than controls– a relatively
large effect size for a vaccination intervention. Limiting broad dissemination of PCOM is the significant level of
research team facilitation needed to teach practices how to use the PCOM components. To address this, we
propose to develop a “Virtual” version of the PCOM intervention (“PCOM-Virtual”) and test it for non-inferiority
to the original PCOM intervention (“PCOM-Standard”) for increasing adolescent HPV vaccination. By using
Dissemination & Implementation (D&I) science principles throughout the process and collecting information on
how contextual practice, provider and patient factors influence PCOM use, we anticipate creating a “shelf
ready” version of PCOM with an associated “User Manual” to foster dissemination. Our Aims are to:
1. Develop the “PCOM-Virtual” intervention using principles of D&I Science from existing prototypes.
2. Compare the efficacy of “PCOM-Virtual” vs. “PCOM-Standard” in improving adolescent HPV vac-
cine utilization. A cluster-randomized non-inferiority trial will be conducted in 30 primary care practices in
Kansas – a locale with some of the lowest adolescent HPV vaccination rates nationally.
3. Examine whether practice, patient and provider characteristics are associated with variability in
the efficacy of PCOM-Virtual and PCOM-Standard. Mixed methods and the PRISM framework will facili-
tate understanding how context influences the interventions' implementation to inform a User Manual.
By creating an easily implementable version of the PCOM intervention, and disseminating it widely we believe
we can have a substantial impact on adolescent HPV vaccination levels.