NEW qualitative research sheds light on the complex factors shaping vaccination decisions among patients with inflammatory rheumatic and musculoskeletal diseases (iRMD), highlighting the central role of trust, clear communication, and coordinated care between healthcare professionals.
Patients with iRMD face an increased risk of infection due to both their underlying autoimmune conditions and the use of immunosuppressive therapies. Despite clear recommendations supporting vaccination in this population, vaccination coverage in Germany remains suboptimal. To better understand why, researchers conducted an in-depth qualitative study exploring perspectives from patients, general practitioners (GPs), and rheumatologists.
Exploring Perspectives Across Care Settings
The study involved semi-structured interviews with 15 patients living with iRMD, alongside 10 GPs and five rheumatologists practising in Germany. Using Kuckartz’s structured content analysis, researchers examined attitudes towards vaccination, information needs, decision-making processes, and perceptions of professional roles within vaccination care.
Across all groups, a trust-based doctor–patient relationship emerged as a key facilitator of vaccination uptake. Patients who felt listened to and well informed by their physicians were more likely to express willingness to be vaccinated. Consistent, comprehensible, and personalised information was particularly important for addressing concerns related to vaccine safety and effectiveness.
Barriers: Uncertainty and Fragmented Responsibility
Several barriers to vaccination were identified. Patients frequently reported uncertainty about vaccine compatibility with immunosuppressive treatments, while conflicting or inconsistent recommendations from different healthcare providers further undermined confidence. A recurring theme was the lack of clarity around responsibility: patients were often unsure whether vaccinations should be initiated by their GP or their rheumatologist.
Physicians echoed these concerns. Both GPs and rheumatologists highlighted gaps in role definition and challenges in interprofessional coordination. While clinicians recognised the importance of collaboration, time constraints, fragmented healthcare structures, and limited opportunities for structured communication were seen as major obstacles.
Patients Want Proactivity
Patients consistently expressed a desire for a more proactive approach from their physicians. Rather than having to initiate conversations themselves, they expected vaccination needs to be anticipated and addressed as part of routine care, particularly when immunosuppressive therapy was being planned.
The authors emphasise that timely vaccination, ideally before starting immunosuppressive treatment, requires clear ownership of the process and efficient information flow between specialists and primary care providers.
Implications for Practice
The findings underscore that improving vaccination rates in iRMD is not solely a matter of patient education, but of system-level coordination. The authors conclude that targeted information services, clearly allocated responsibilities between GPs and rheumatologists, and structured, transparent communication pathways are essential to support informed decision-making.
Together, these insights provide a foundation for developing practical, patient-centred interventions aimed at increasing vaccination uptake in this high-risk population, while reinforcing trust and continuity across rheumatology care pathways.
Reference
Suslow A et al. Factors influencing vaccination decisions in patients with inflammatory rheumatic and musculoskeletal disease: a qualitative approach. BMC Rheumatol. 2026;DOI: 10.1186/s41927-025-00608-6.
