Misconception contributed to COVID-19 vaccine hesitancy in patients with lung cancer or ground-glass opacity: a cross-sectional study of 324 Chinese patients

ABSTRACT

Patients highly vulnerable for COVID-19 infection have been proposed to take priority for vaccination. However, vaccine hesitancy is usually more prevalent in these patients. Investigation around modifiable contributors of vaccine hesitancy plays a pivotal role in the formulation of coping strategies. We aimed to evaluate the impact of vaccine misconception in patients with lung cancer or pulmonary ground-glass opacity (GGO). A web-based questionnaire was constructed based on a qualitative interview with 15 patients and reviewed by a multidisciplinary expert panel. Six Likert five-scale questions were used to generate a score of vaccine misconception (SoVM), which ranged from 0 to 24 points, with a higher score indicating a higher level of misconception. A total of 61.6% (324/526) patients responded to our questionnaire. A higher proportion of low willingness patients (n = 173), compared to high willingness patients (n = 151), disagreed that cancer patients should be prioritized for COVID-19 vaccination (82.1% vs. 50.3%, p < .001) and perceived themselves to have contraindications (45.7% vs. 15.9%, p < .001). The mean SoVM was significantly lower in the high willingness group than the low willingness group (9.9 vs. 13.0, p < .001). Among the unvaccinated patients, the SoVM increased as the willingness to be vaccinated decreased (p < .0001). In multivariable logistic regression, patients with higher SoVM (OR 0.783, 95% CI 0.722–0.848), being female (OR 0.531, 95% CI 0.307–0.918) or diagnosed with lung cancer (OR 0.481, 95% CI 0.284–0.814) were independently associated with a lower willingness to be vaccinated against COVID-19. Receiver operating characteristic curve suggested that a SoVM of 11 yielded the best discrimination for predicting the willingness to receive COVID-19 vaccine (AUC = 0.724). The study findings reveal that patient misconception significantly contributes to vaccine hesitancy and needs to be addressed by evidence-based education tailored to their specific concerns.

KEYWORDS:

• COVID-19
• vaccine
• vaccine hesitancy
• misconception
• cancer
• pulmonary ground-glass opacity
• patient education
• vaccination campaign

Acknowledgments

The authors thank all the patients and their caregivers for participating in our qualitative interview, expert panel review and the survey study.

Author Contributions

Concept and design: W.Z. and G.Q.; Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: W.Z., J.Z., Z.L., P.W., and C.Z.; Critical revision of the manuscript for important intellectual content: G.Q., W.Z., Q.S. and R.C.; Obtained funding: G.Q.; Supervision: Q.S., and G.Q.

Institutional review board statement

This study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Guangdong Provincial People’s Hospital (approval number: KY-Q-2021-087-01).

Informed consent statement

Online informed consents were obtained from all subjects involved in the study.

Disclosure statement

All authors declare no conflict of interest.

Data availability statement

All anonymous data are available from corresponding author ([email protected]) on reasonable request.

Supplementary Material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2021.1992212.

Additional information

Funding

This study was funded by the 2020 Guangdong Provincial Special Project for Popularization of Science and Technology Innovation [grant number: 2020A1414070007].