Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC) is common and morbid. A screening approach for HPV+ OPC which incorporates biomarkers and behavioral and sexual risk factors is promising (PMID: 31454434), yet patient perspectives about this approach are unknown.
Methods: The study applied a descriptive, cross-sectional qualitative design and was nested within, and performed in parallel to, a large prospective observational cohort screening trial (Throat and other HPV-Related cancers IN men: Identifying Them early [TRINITY]) enrolling >1,500 middle-aged men at three academic medical centers. For this study, the subpopulation included middle-aged males (ages 50-64) who were invited to participate in the TRINITY trial at one of the three medical centers. We aimed to interview 45 total subjects across three groups: TRINITY trial participants (Group A), subjects who declined to participate outright (Group B), and subjects who initially expressed interest in the TRINITY trial but did not ultimately participate (Group C). We framed the study using the socioecological model and the four-part model of behavioral change (knowledge-attitudes-ability-reinforcement), which has been specifically applied to evaluation of cancer screening. Interviews were conducted from July 2023 to March 2024. The transcripts were thematically analyzed using NVivo 12.0 and a mixed deductive-inductive approach. A codebook was drafted, and two study authors independently coded three transcripts, yielding an interrater reliability of 0.89. The remaining transcripts were single-coded by either of the two study authors. Overall thematic findings and representative quotes were identified and interpreted by the research team.
Results: Among the 70 males invited, 44 were enrolled in the study (Group A: 15; Group B: 15; Group C: 14). Patient characteristics were: mean age: 59; non-Hispanic white race/ethnicity: 88%; married: 61%; median income by zip code: $86,826; and average distance from screening site: 37 miles. There were no differences in patient-level characteristics between groups, except Group B patients lived significantly further from the screening site (48 miles, p<0.05). We identified several key findings. First, most subjects exhibited limited knowledge about HPV and HPV-mediated OPC (n=29/44; 65%). Second, convenience is a major determinant of screening participation (n=39/44; 89%); specifically, barriers to screening included the time required to screen (n=28/44; 64%), intensity of screening tests (n=27/44; 62%), and proximity of the screening location (n=19/44; 43%). Third, barriers to providing a sexual history included concerns about loss of confidentiality (n=28/44; 64%), memory limitations (n=8/44; 18%), and stigma (n=28/44; 55%). Despite these barriers, all participants reported they were comfortable providing their sexual history for screening purposes through various modalities, with a secure online form (n=37/44; 84%) and in-person (n=36/44; 82%) being the most comfortable options.
Conclusion: Lack of knowledge and lack of ability to undergo screening tests are major potential barriers to screening for HPV and HPV+ OPC in middle-aged males. Providing sexual history data is not a major barrier to screening, although allowing for multiple modes of data provision may be preferred. These data may inform the design of future screening trials and lend support to approaches that reduce barriers to participation, including at-home testing.