and Prevention, 2019b). It is the clinician’s responsibility to provide adequate information about screening and treatment options using plain, colloquial language (National Institutes of Health, 2018; Centers for Disease Control and Prevention, 2019c). Additionally, patient education information, both print and verbal, should be tailored to the patient’s level of understanding. Clinical guidelines in this area suggest taking extra time to listen to the patient’s questions and concerns, using plain language and speaking slowly when discussing all aspects of screening and outcomes, using educational materials to supplement facts, providing information in small amounts to facilitate understanding, and using the “teach back” approach in which patients describe the information received to the provider in their own words to confirm understanding (Centers for Disease Control and Prevention, 2019d; Health Resources and Services Administration, 2019). Everyone benefits from clear communication so the risks, benefits, and consequences of treatment or no treatment can be understood (Centers for Disease Control and Prevention, 2019c). Any testing should be preceded by a discussion regarding the implications of a positive or negative test result in relation to virus transmission, prognosis, treatment, and risk of recurrence (Dodd, et al., 2019). It is important for patients to understand that HPV-related oral cancer can occur 10 years or more after exposure to the virus making regular oral examinations and the associated oral cancer screenings extremely important (Taberna, et al., 2017). A variety of patient education materials are available, many without cost. When choosing patient education materials or developing your own, make sure they are written in plain language. A number of resources are available to aid in choosing or developing educational materials. The information is also a useful guide for anyone wanting to learn more about patient communication. See the Resources section for more information. Negative results Negative test results should be presented along with patient education regarding HPV prevention, including information on risk factors and consistent safe sex practices. Patients should be advised that a negative test does not ensure future negative test results. If the patient is a candidate for any of the HPV vaccines, counseling in this area should be offered. Positive results Patients may react in different ways to a positive HPV test (Dodd, et al., 2019). Positive results may lead to questions from patients, including those regarding prognosis, which health professionals should be prepared to discuss (You, et al., 2019). Frequently asked questions by patients receiving a positive test result relate to the following five areas of concern: ● Virus transmission. ● Prevention. ● Duration of infection and progression to cancer. ● Treatment. ● Information for partners. (Dodd, et al., 2019; You, et al., 2019) Table 3 presents questions that are frequently asked by patients who have received a positive test result.
(oral, genital, and anal) and consistent use of barrier protection during sexual activity is important. Often patients feel that these questions are asked in order to label sexual behaviors as promiscuous or not. Explaining to a patient that the number of sexual partners signifies an individual’s level of potential exposure to the virus can sometimes alleviate associated anxiety. Inquiring about an individual’s number of past sex partners is similar to asking smokers how long they have smoked and the number of packs per day smoked – a question that allows the number of pack years to be determined and provides a quantifiable measure of health risks from smoking. Just as higher numbers of pack years increase the associated health risks with smoking, higher numbers of sexual partners increase a person’s probability of acquiring the virus as a result of greater viral exposure (D’Souza, et al., 2017). It may also be useful to emphasize to any patient that a person can acquire HPV during an initial sexual contact. Patients testing positive for HPV, whether oral or genital, often have a number of questions relating to where and when they contracted the virus, as well as concerns about transmitting the virus to others. Concerns about the potential for developing an HPV-associated malignancy or for those who have been diagnosed with this malady include concerns about post-surgical body image, social reintegration, demoralization and the fear of a recurrent malignancy (You, et al., 2019). Others are concerned about the associated health risks. Individuals receiving positive HPV genital/anal test results report feeling frightened, anxious, regretful, angry, and/or panicked with many patients feeling stigmatized and embarrassed by this diagnosis which may preclude sharing this information with their partners (You, et al., 2019). People diagnosed with other STIs report feelings of depression and anger, and a loss of self-esteem. Anger toward the person suspected of being the source of infection is also common, concerns about negative reactions from family and friends and worry about the long-term health implications are among the myriad of emotions and concerns expressed by patients with an HPV diagnosis (Dodd, et al., 2019). Education is an important component of discussion prior to testing. Although oral HPV infection has been a prominent media feature in the past few years, much confusion, ignorance, and misinformation exists among the general public (American Dental Association, 2022). It is important to understand the negative effect that confusion can have on a patient’s understanding of his or her HPV diagnosis and prognosis, and ultimately the stigma, fear and self-blame which can develop. (Dodd, et al., 2019). Discussing screening results Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Health Resources and Services Administration, 2019). Health literacy is an important factor affecting patient communication and decision making (Centers for Disease Control and Prevention, 2019b) and is more than a patient’s ability to read and correctly pronounce dental terminology (National Institutes of Health, 2018). Low health literacy affects not only individuals with low general literacy, but those who may be highly literate in their field of expertise but have a limited understanding of medical or dental terminology (Centers for Disease Control
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