Clinician Perspectives on Implementing HPV Vaccination Guidelines into Practice.

In the United States, HPV vaccination is available for unvaccinated 27 to 45 year olds based on a shared clinical decision with a health care provider. Since the implementation of the guideline, little has been known about provider perceptions of this recommendation. The purpose of this study was to elucidate health care provider perspectives on HPV vaccination for 27 to 45 year olds in the United States. Semi-structured interviews were conducted virtually with 18 health care providers regarding current HPV vaccination practices for 27 to 45 year olds, perceptions of the guideline, and shared clinical decision-making needs. Thematic analysis was conducted using interview transcripts, and interrater reliability was achieved for >10% of the transcripts. Overall, most participants reported that they have recommended HPV vaccination to patients aged 27 to 45 year olds; however, they applied various criteria to guide these discussions. Some participants considered the patients' relationship statuses, sexual partnerships, past HPV infection history, and age. Potential needs to facilitate shared clinical decision-making processes included medical record prompts and brief educational materials. While most health care providers in this sample discussed HPV vaccination with their patients ages 27 to 45 years old, there were inconsistencies in the interpretation of the guideline. The lack of specificity in the recommendation will likely result in significant and potentially inequitable implementation difficulties.