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You are here: Home / Articles / COVID-19 Vaccination in Patients with Rheumatic Disease

COVID-19 Vaccination in Patients with Rheumatic Disease

August 11, 2021 • By Ruth Jessen Hickman, MD

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Dusan Petkovic / shutterstock.com

Dusan Petkovic / shutterstock.com

With a large percentage of the U.S. population unsure whether they will get vaccinated against COVID-19, rheumatology patients remain vulnerable. On May 13, the ACR hosted a virtual town hall highlighting ways rheuma­tology providers might effectively approach their patients who have not yet decided to get a COVID-19 vaccine.

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Get the Slow Yes

headshot of Dr. Kimberly Manning

Dr. Manning

At the outset, Kimberly Dylan Manning, MD, FACP, FAAP, a professor of medicine and the associate vice chair of diversity, equity and inclusion at Emory University School of Medicine, Atlanta, expressed her dislike of the term vaccine hesitancy. She prefers the term deliberation, the act of thinking and deciding carefully about something, which she believes imparts more power to both patients and providers. After all, different people need different information to be comfortable making big decisions.

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Repeatedly, Dr. Manning emphasized the importance of building rapport: “What kind of therapeutic alliance have you worked at to make sure [your patient] wants to say yes to you?” she asked. Body language and inviting intonation are key, as are respectfully listening to patients and showing you have heard them.

From attentive listening, clinicians can gain valuable information they can use to influence their patients over time. Eventually, some patients will slowly turn from a no toward a yes. “That’s one of the most encouraging things,” said Dr. Manning. “Depending on who you are, your deliberation process might require a little bit more. Just keep planting that seed.”

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Not all patients have the same questions about, or knowledge of, COVID-19 vaccination. Asking patients about their specific concerns allows clinicians to tailor the response to the patient. For example, a patient may bring up a concern about how quickly the vaccine was created. It’s helpful to acknowledge and validate the concern. Then a clinician may provide specific reassuring context—explaining that researchers have been studying other coronaviruses for years and work on mRNA vaccines is not new.

You may mention the new vaccines were subjected to all the typical steps in vaccine development and evaluation, including phase 1, 2 and 3 clinical trials. Don’t assume your patient knows what that means. Provide an explanation: “That means studies were conducted in people, not just animals, beginning with tests in a few healthy volunteers (under a hundred) and moving up to large-scale tests in people with the disease (hundreds to thousands) to ensure the vaccine is safe and works as intended. The vaccines are safe. More than 302 million people in the U.S. have now been vaccinated, with rare serious side effects and very few deaths—about 7 per 1 million vaccinated women between 18 and 49 years old—positively linked to vaccination.”1

“When we start respecting our patients [and giving them] the science,” said Dr. Manning, “you’ll be surprised at how many people will say, ‘That makes sense.’”

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Pages: 1 2 3 | Single Page

Filed Under: Conditions, Patient Perspective Tagged With: COVID-19, patient communication, vaccination, vaccine hesitancyIssue: August 2021

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About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

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