Date of Award

1-1-2023

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Benjamin L. Judson

Abstract

Introduction; The incidence of HPV-associated oropharyngeal squamous cell carcinoma(OPSCC) has increased significantly over the past several decades, however public awareness of HPV’s role in head and neck cancer remains markedly low. There is evidence to suggest that addressing this knowledge gap through patient education initiatives may help increase HPV vaccination rates. To this end, we introduce a brief educational intervention into routine otolaryngology clinic visits to increase patient knowledge of the link between HPV and oropharyngeal cancer, and to encourage HPV vaccination. We aimed to test the feasibility of a simple, in- office intervention and to assess its efficacy in improving patient knowledge and reported willingness to vaccinate. In addition, we briefly explore use of generative artificial intelligence in improving patient education material.

Methods: Patients presenting to Yale New Haven Hospital’s Yale Physician Building 4th floorotolaryngology clinic were enrolled in the study. Patients completed a pre- intervention questionnaire in the waiting room. They were then provided a handout including four key facts relating to HPV exposure risks, the role of HPV in oropharyngeal cancer, and the ability of the HPV vaccine to decrease risk of oropharyngeal cancer. During the visit, patients were asked about their vaccination status by their physician and were given an opportunity for further discussion. Following the visit, patients completed a post-intervention questionnaire assessing their knowledge as well as their attitudes towards HPV vaccination. Pre- and post- intervention scores for knowledge and attitude questions were compared with McNemar chi-squared and Wilcoxon signed ranks tests using SPSS. To compare artificial-intelligence (AI) generated educational material, online-accessible language learning models ChatGPT (GPT: generative pretrained transformer, from OpenAI) and Claude (from Anthropic) were queried using standardized prompts in a post-hoc case study. Model outputs were compared qualitatively.

Results: The study included 64 patients (76 were enrolled, 12 did not complete thequestionnaires). Ages ranged from 15 to 79, with a mean age (±SD) of 43.51 (±17.84) years. Our population was predominantly white (73.4%) with a relatively equal sex distribution (53.1% identified as male). Most patients (73.4%) had heard of HPV, but only 26.6% had been vaccinated for HPV. When asked about four key facts regarding HPV and oropharyngeal cancer, only 10.9% answered all four questions correctly pre-intervention. This increased to 68.8% after the intervention. Regarding risks of HPV exposure, 34.4% of patients believed that they or their family were likely to have been exposed to HPV prior to intervention, which increased to 59.4% (p

Conclusions: Our study demonstrates that a simple intervention, consisting of an educationalfact sheet along with the opportunity for further discussion with an otolaryngologist, significantly increases patient knowledge about HPV’s role in OPSCC and increases patient willingness to vaccinate both themselves and their children against HPV. Otolaryngologists should consider incorporating similar educational interventions into routine practice to increase public knowledge surrounding HPV and oropharyngeal cancer, encourage HPV vaccination, and ultimately reduce the burden of HPV-associated oropharyngeal disease. Additionally, generative AI may be an effective approach to design and enhance simple and effective material for patient educational interventions, though human supervision and expert review remains necessary.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 04/30/2026

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