Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2023; 11(4): 821-829
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.821
Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions
Inbar Caspi, Ophir Freund, Omer Pines, Odelia Elkana, Jacob N Ablin, Gil Bornstein
Inbar Caspi, Ophir Freund, Gil Bornstein, Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
Omer Pines, Odelia Elkana, Behavioral Sciences Department, Academic College of Tel Aviv-Yaffo, Tel Aviv 6818211, Israel
Jacob N Ablin, Internal Medicine Department H, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv 6423906, Israel
Author contributions: Ablin JN and Bornstein G designed and supervised the study; Freund O, Pines O, Elkana O and Caspi I performed data acquisition, analysis and interpretation; Caspi I and Freund O drafted the manuscript; All authors reviewed and confirmed the final version of the manuscript and critically revised it.
Institutional review board statement: The study was approved by the ethics committee of The Academic College of Tel Aviv-Yaffo (Authorization No. 2021142).
Informed consent statement: All participants accepted an informed consent form, agreed to participate by pressing to continue with the questionnaire electronically and had the ability to drop out at any stage.
Conflict-of-interest statement: The authors declare having no conflicts of interest, real or perceivable, to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ophir Freund, MD, Doctor, Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 6423906, Israel. ophir068@gmail.com
Received: October 27, 2022
Peer-review started: October 27, 2022
First decision: November 30, 2022
Revised: December 12, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 6, 2023

The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in patient care worldwide. Vaccinations, which have proven efficacious in lowering the COVID-19 hospital burden, are still avoided by large populations. We, therefore, hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.


To evaluate whether patient vaccine hesitancy affected the hospital care team (HCT) perceptions.


We performed a prospective clinical study using structured questionnaires. We approached physicians and nurses with previous experience caring for COVID-19 patients from 11 medical centers across Israel during the fourth COVID-19 surge (September and October 2021). The participants completed a questionnaire with the following parts: (1) Sociodemographic characteristics; (2) Assessment of anger (STAXI instrument) and chronic workplace stress (Shirom-Melamed burnout measure); and (3) Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions (the difficult doctor-patient relation questionnaire, the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire). Results were evaluated according to each part of the questionnaire and the questionnaire as a whole. Associations between HCT perceptions and their baseline characteristics, anger or chronic workplace stress were assessed.


The HCT experienced their relationship with unvaccinated patients as more difficult (P < 0.001, Cohen’s d = 0.85), perceived unvaccinated patients as responsible for their medical condition (P < 0.001, d = 1.39) and perceived vaccinated patients as having a higher character value (P < 0.001, d = 1.03). Unvaccinated patients were considered selfish (P < 0.001), less mature (P < 0.001) and less satisfying to care for (P < 0.001). The relationship with unvaccinated patients was more difficult among HCT with higher burnout (r = 0.37, n = 66, P = 0.002). No correlations with baseline characteristics were found. All three study tools showed high internal consistency (α between 0.72 and 0.845).


Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients. In order to minimize the potential negative impact on patient care, designated departments should promote specific patient-centered preparations. Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.

Keywords: COVID-19, Vaccination, Hesitancy, Patient care, Doctor-patient relationship, Attitudes

Core Tip: Coronavirus disease 2019 (COVID-19) vaccine hesitancy is common around the world. We considered that patient vaccine hesitancy could affect the hospital care team perceptions. To test that possibility, we implemented a questionnaire during the Delta variant surge among physicians and nurses with prior experience in caring for COVID-19 patients. We found that patient vaccine hesitancy negatively affected how the medical care team perceived these patients and their care. Vaccine hesitancy can negatively affect the physician-patient relationship and raising awareness of this important issue is crucial for proper interventions.