Vaccination against the human papillomavirus: development of a digital shared-decision aid for general practitioners in France (Preprint)

Abstract

Human papillomaviruses (HPV) are responsible for the most common sexually transmitted infection in the world and persistent infection of oncogenic types is associated with an increased risk of cancers. This infection could be prevented by vaccination. However, in a time of vaccine hesitancy, the decision to get vaccinated or to have a child vaccinated is the result of a complex process and decision aids are tools that may be of help in this context.

The aim of this article is to present the development of a shared decision aid for HPV vaccination in France, destined to be used during general practice consultations. The construction of the shared decision aid is a part of the PrevHPV experimental study, an evaluation of a multicomponent intervention aiming to improve HPV vaccination coverage.

In order to develop the decision support tool, we followed the steps recommended by the International Patient Decision Aids Standard (IPDAS), i.e. scoping and defining the objectives, assembling the steering group, designing (carrying out two focus groups and a narrative review of the literature) and testing in a alpha test phase (carrying out three focus groups and 11 individual interviews). The tool was co-constructed with adolescents, parents and general practitioners.

We created an online shared decision aid which included the definition of HPV, epidemiological data, the mode of contamination, the different locations of the disease, the development of cancer, the importance of Pap smears, the effectiveness of the vaccination as well as the possible side effects. The various focus groups as well as individual interviews made it possible to determine the values and expectations of patients and physicians thus improving the decision aid. This development also made it possible to confirm an existing need for this type of tool for both patients and physicians.

We have developed a shared decision aid that could help general practitioners communicate about HPV vaccination and get more patients vaccinated. This SDA will be validated in a beta-testing phase. The impact of its use during the consultation will be evaluated on criteria such as the resolution of the decision-making conflict and ultimately on the vaccination coverage, as part of the PrevHPV study.