Impact of Standing Orders Optimization

N/AActive Not RecruitingNCT05742386

UNC Lineberger Comprehensive Cancer Center27 enrolled

Overview

This trial will look at the impact of optimizing human papillomavirus (HPV) vaccine standing orders. The research team will work with primary care clinics. Some clinics will receive communication training. Other clinics will receive the same training and tools for increasing the use of their standing orders.

The researchers will conduct a cluster randomized clinical trial. The trial will look at the impact of optimizing HPV vaccine standing orders. The recruitment goal for the trial is 34 clinics in healthcare systems, including 9 rural-serving clinics. The researchers will randomize clinics using simple randomization (1:1). Some clinics will receive a communication training. Other clinics will receive a communication training and tools for optimizing the use of their standing orders. The researchers will use medical record data to compare changes in HPV vaccination among children ages 9-12. Clinics will be followed for 24 months. The researchers will also use survey data to compare HPV vaccine communication and implementation of standing orders among clinical staff. The study will engage clinical staff. Researchers will not have direct contact with children or their families.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Human Papilloma Virus

Interventions

Communication trainingBEHAVIORAL

Clinics will host an AAT workshop. A trained facilitator will use a standard script and slides to deliver workshop in-person or over Zoom; clinical staff who are unavailable will take the workshop later on their own.

Communication training enhanced with standing orders optimizationBEHAVIORAL

Clinics will host an AAT workshop, as in the other trial arm. Clinic representatives will attend working meetings on putting HPV vaccine standing orders into clinic workflow. Clinics will then orient their staff to the standing orders. Finally, clinic representatives will discuss their use of standing orders in a learning collaborative.

Eligibility

Sex: ALLMin age: 9 YearsMax age: 12 Years

Medical Language ↔ Plain English

This trial will enroll clinics and intervene with clinical staff. We will use vaccination data from children and survey data from clinical staff to evaluate intervention effectiveness. We will not enroll children or interact with them directly. Inclusion Criteria Clinics are eligible if they: * provide HPV vaccine to children ages 9-12 * have standing orders for HPV vaccination approved but not routinely used or be willing to adopt them prior to the start of the trial * have rates of HPV vaccination (≥1 dose) below 72%, boys and girls combined Children's medical records will be eligible to be included in the dataset if children: * are between the ages of 9-12 years at baseline * are attributed to a participating clinic at 12- or 24-month follow-up Clinical staff's survey data will be eligible to be included in the dataset if clinical staff complete the follow-up survey. Exclusion Criteria Clinics are excluded if they: * do not provide HPV vaccine to children ages 9-12 * do not have standing orders for HPV vaccination or are not willing to adopt them prior to the start of the trial * have rates of HPV vaccination (≥1 dose) above 72%, boys and girls combined * have hosted an AAT workshop in the previous 3 years or are part of current HPV vaccine communication trainings * have quality improvement efforts to change HPV vaccine standing orders during the trial Children's medical records will not be eligible to be included in the dataset if children: * are not between the ages of 9-12 years at baseline * are not attributed to a participating clinic at 12- or 24-month follow-up * are receiving hospice/palliative care, are pregnant, or have a history of HPV vaccine contraindications Clinical staff's survey data will be not eligible to be included in the dataset if clinical staff do not complete the follow-up survey.

Locations (1)

The University of North Carolina at Chapel Hill

Chapel Hill, North Carolina, United States

Outcomes

Primary Outcomes

HPV vaccination (≥1 dose), 9-12 year olds

Proportion of unvaccinated children who initiate the HPV vaccine series between baseline and 12-month follow-up, among those who were ages 9-12 at baseline.

Time frame: from baseline to 12 months

Secondary Outcomes

HPV vaccination (≥1 dose), 9-12 year olds

Proportion of unvaccinated children who initiate the HPV vaccine series between 13- and 24-month follow-up, among those who were ages 9-12 at 13 months.

Time frame: from 13 months to 24 months

HPV vaccination (≥2 doses), 9-12 year olds

Proportion of unvaccinated children who complete the HPV vaccine series between baseline and 12-month follow-up, among those who were ages 9-12 at baseline.

Time frame: from baseline to 12 months

HPV vaccination (≥2 doses), 9-12 year olds

Proportion of unvaccinated children who complete the HPV vaccine series between 13- and 24-month follow-up, among those who were ages 9-12 at 13 months.

Time frame: from 13 months to 24 months

Standing orders attitude rating

Positive attitude toward using HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating more positive attitudes.

Time frame: up to 6 months

Standing orders norms rating

Norms in favor of using HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating more supportive norms.

Data from ClinicalTrials.gov

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Time frame: up to 6 months

Standing orders self-efficacy rating

Confidence about using HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating higher confidence.

Time frame: up to 6 months

Standing orders adoption rating

Adoption of HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating greater adoption.

Time frame: up to 6 months

Standing orders acceptability rating

Acceptability of HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating higher acceptability.

Time frame: up to 6 months

Standing orders appropriateness rating

Appropriateness of HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating greater appropriateness.

Time frame: up to 6 months

Standing orders role rating

Understanding of role under HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating better understanding of role.

Time frame: up to 6 months

Standing orders feasibility rating

Feasibility of HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating greater feasibility.

Time frame: up to 6 months

Standing orders sustainability rating

Sustainability of HPV vaccine standing orders will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating greater sustainability.

Time frame: up to 6 months

Estimated time spent on recommendations

Time spent on HPV vaccine recommendations will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 0-99 minutes, with higher values indicating more time spent.

Time frame: up to 6 months

Estimated recommendation frequency, 9-10 year olds

Frequency of recommending HPV vaccine for children ages 9 or 10 will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating more frequent recommendations.

Time frame: up to 6 months

Estimated recommendation frequency, 11-12 year olds

Frequency of recommending HPV vaccine for children ages 11 or 12 will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating more frequent recommendations.

Time frame: up to 6 months

Recommendation attitudes rating

Positive attitudes toward recommending HPV vaccine for ages children ages 9 or 10 years will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating more positive recommendation attitudes.

Time frame: up to 6 months

Recommendation self-efficacy rating

Confidence in recommending HPV vaccine for children ages 9 or 10 will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating higher recommendation confidence.

Time frame: up to 6 months

Recommendation norms rating

Norms in favor of recommending HPV vaccine for children ages 9 or 10 will be measured by one item on the survey, taken by clinical staff two months after attending the AAT. The range for this measure will be 1 to 5, with higher values indicating more supportive norms.

Time frame: up to 6 months

Recommendation intentions rating

Intentions to recommend HPV vaccine for children ages 9 or 10 will be measured by one item on the survey, taken by clinical staff two months after attending the AAT The range for this measure will be 1 to 5, with higher values indicating higher recommendation intentions.

Time frame: up to 6 months