When clinicians and patients disagree on vaccination: what primary care clinicians can learn from COVID-19-vaccine-hesitant patients about communication, trust, and relationships in healthcare

Abstract

Abstract Background In the United States, discourse on COVID-19 vaccination has become polarized, and the positions of public health officials are met with skepticism by many vaccine-hesitant Americans. This polarization may impact future vaccination efforts as well as clinician-patient relationships. Methods We interviewed 77 vaccine-hesitant patients and 41 clinicians about COVID-19 vaccination communication in primary care as part of a Veterans Affairs (VA) trial evaluating a vaccine-communication intervention. This paper reports the findings of a qualitative analysis focused on one aspect of those interviews—the disconnect between primary care clinicians’ and patients’ perceptions about COVID-19 vaccination communication and decision-making. Results Rapid qualitative analysis of semi-structured interviews revealed fundamental differences in how clinicians and patients understood and described the reasoning, values, and concerns underlying COVID-19 vaccine hesitancy. These differences were significant and value-laden; they included negative judgments that could undermine communication between clinicians and patients and, over time, erode trust and empathy. Conclusion We advocate for empathic listening and suggest communication strategies to bridge the divide between clinicians and vaccine-hesitant patients.

Keywords

• COVID-19 vaccination
• Vaccine hesitancy
• Healthcare communication
• Healthcare relationships
• Motivational interviewing
• Trust