Human Papillomavirus Vaccine Communication Skills for Pediatric Primary Care Clinicians: Evaluation of a Randomized Clinical Trial of the C-LEAR Training on Clinicians' Behavior.
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OBJECTIVE: Cancer prevention can be improved through increasing the uptake of the human papillomavirus (HPV) vaccine resulting from enhanced pediatric primary care clinician recommendations. Although clinician recommendation has been shown repeatedly to be associated with increased vaccination, quality recommendations are not always given. STUDY DESIGN: Thirty pediatric clinics and their 58 respective clinicians were randomized using a cluster design to 3 groups regarding trainings for recommending the HPV vaccine to parents of 11- to 12-year-olds: (1) the Counsel-Listen-Empathize-Answer-Recommend (C-LEAR) approach with bundled counseling (all 3 vaccines together) (n = 20), (2) the C-LEAR approach with benefits counseling (focused on HPV vaccine benefits) (n = 17), and training deferred to after the trial (n = 21). Training consisted of a 1-hour virtual session, including small group role play. As a secondary outcome, we evaluated clinicians' adherence through simulated and real patient visits and self-reported surveys. RESULTS: Of the 37 clinicians, 36 completed the training. Adherence to the C-LEAR approach averaged 77% during simulated patient visits (n = 35), 68% in real patient visits (n = 22), and 82% on monthly surveys (n = 31). During the simulated patient visits, the clinicians trained in the bundled group had significantly greater adherence than the benefits group to the C-LEAR approach. During real patient visits, some, but not all, of the counseling statement components were more likely to be used by clinicians trained to use them, compared with untrained clinicians. Comparing the self-reported counseling statements of HPV vaccine recommendation before and 1 year after the training, the frequency of using 3 or more of the trained components remained similar in the deferred and bundled groups and increased within the benefits group. CONCLUSION: Following a brief, virtual, communication skills workshop using the C-LEAR approach for vaccine communication, trained clinicians were more likely than untrained clinicians to use some of the counseling strategies consistent with recommended approaches.