Human papillomavirus status in head and neck cancer

Human papillomavirus (HPV) is an emerging causative factor for squamous carcinoma of the oropharynx and perhaps other head and neck cancers. There is a great deal of uncertainty regarding the clinical significance and implications of HPV status in this patient population. As a result, there is no established protocol for informing patients of the potential link between viral infection and their cancer. This paper discusses some of the ethical issues involved with informing head and neck cancer patients of their HPV status, recognizing the dilemma posed by unresolved clinical questions and the need to respect the autonomy of patients by disclosing relevant information. Cancer 2010; 116:4221–6. © 2010 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78080/1/25210_ftp.pd

Facilitating implementation of research evidence (FIRE): A randomised controlled trial and process evaluation of two models of facilitation informed by the promoting action on research implementation in health services (PARIHS) framework

Background: The PARIHS framework proposes that successful implementation of research evidence results from the complex interplay between the evidence to be implemented, the context of implementation and the facilitation processes employed. Facilitation is defined as a role (the facilitator) and a process (facilitation strategies/methods). Empirical evidence comparing different facilitation approaches is limited; this paper reports a trial of two different types of facilitation represented in the PARIHS framework. Methods: A pragmatic cluster randomised controlled trial with embedded process evaluation was undertaken in 24 long-term nursing care settings in four European countries. In each country, sites were randomly allocated to standard dissemination of urinary incontinence guideline recommendations and one of two types of external-internal facilitation, labelled Type A and B. Type A facilitation was a less resource intensive approach, underpinned by improvement methodology; Type B was a more intensive, emancipatory model of facilitation, informed by critical social science. The primary outcome was percentage documented compliance with guideline recommendations. Process evaluation was framed by realist methodology and involved quantitative and qualitative data collection from multiple sources. Findings: Quantitative data were obtained from reviews of 2313 records. Qualitative data included over 332 hours of observations of care; 39 hours observation of facilitation activity; 471 staff interviews; 174 resident interviews; 120 next of kin/carer interviews; and 125 stakeholder interviews. There were no significant differences in the primary outcome between study arms and all study arms improved over time. Process data revealed three core mechanisms that influenced the trajectory of the facilitation intervention: alignment of the facilitation approach to the needs and expectations of the internal facilitator and colleagues; engagement of internal facilitators and staff in attitude and action; and learning over time. Data from external facilitators demonstrated that the facilitation interventions did not work as planned, issues were cumulative and maintenance of fidelity was problematic. Implications for D&I Research: Evaluating an intervention - in this case facilitation - that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, as opposed to dose and intensity of the intervention

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are much more likely to receive the HPV vaccination. Purpose: The purpose of this project is to assess the effectiveness of an educational intervention on health care provider’s understanding of the importance of their own vaccine recommendations to adolescent families to improve HPV vaccination rates. Methods: This is a quasi-experimental pretest–posttest design. The sample includes medical providers and clinical staff of the University of Kentucky Adolescent Medicine Clinic. Participants completed a pre-survey, an educational quality improvement (QI) session, and post-survey derived from an evidence-based HPV IQ toolkit from the University of North Carolina Gillings School of Public Health. Likert scales were used to analyze provider and clinic staff attitudes before and after the session, perceived importance of components of the session, and to evaluate the change in provider attitudes before and after the session. A paired t-test was used to compare provider attitudes before and after the QI session. Clinic HPV immunization rates of 13-year-old males and females were collected from the Kentucky Immunization Registry before the project implementation and three months following the QI session. Results: A total of 13 participants completed the pre-survey and the QI education session in November of 2020. A total of 11 participants completed the post-survey. During the post-survey, participants completed an evaluation of the QI program, which demonstrated overall positive attitudes of providers and clinic staff surrounding the HPV vaccination before the session and improved attitudes after the session. In the three months following the educational intervention, completion of at least one HPV vaccination documented improved from 81% to 86% of UK Adolescent Medicine 13-year-old patients. Conclusion: A gap exists between national recommendations and HPV vaccination completion rates in adolescents due to multiple factors in the United States. Following a QI session, improvement was observed of 13-year-old male and females HPV rates and strength of attitudes of medical staff strength within UK Adolescent Medicine. Although results lacked statistical significance, this study highlights an individual clinic’s ability to obtain tools necessary to set goals, implement evidence-based practices, and improve patient outcomes. Further large participant multi-level evidence-based interventions are recommended