Correcting Misinformation with Patients: Communication Techniques

The NIH CEAL has provided a tip sheet for for health Professionals working with the community. Find the full sheet here.

Identify Key Misinformation in Your Community - Listen to misinformation circulating as community concerns—for example, from trusted messengers, in town halls, as rumors, and on social media. 

Choose Which Misinformation to Address - While all misinformation could be problematic and may need to be addressed, prioritize the most urgent.

Acknowledge and Empathize - In responding to misinformation, consider acknowledging, empathizing with and affirming the person’s (or audience’s) perspective first, then offer fact-based correction. 

Debunk and Explain - Use plain language; be responsive to literacy levels and culturally acceptable language. When possible, proactively provide transparent and easily understandable information before misinformation is circulated widely (sometimes called "pre-bunking")

MS1s in the GI/Liver block are taught about three communication tasks (the 3E's): 

EDUCATE the patient about diagnosis, prognosis and treatment from the physician's point of view and educate him/herself about the patient's thinking (their explanatory model) about these issues. Keep the messages simple.

ENLIST the patient in a doctor-patient partnership to carry out the negotiated treatment plan.

END the visit by providing a smooth transition home. Arrange for the next contact with the doctor. Make sure the patient knows how any test results will be communicated and how best to contact the doctor if needed.

Students are also taught the "teach-back" technique, which stresses that clinicians must take responsibility for adequate teaching. If patients cannot explain or demonstrate what they should do, clinicians must assume that they did not provide patients with an adequate explanation or understandable instructions. The teach-back technique should replace the more common practice of simply asking a patient, “Do you understand what I have told you?” Experience shows that patients often answer “yes” to such questions, even when they understand nothing.

Instead, a clinician can say, “Please explain to me how you will take your medication, so I can be sure I have explained everything correctly,” or “Please show me how you will use the asthma inhaler, so I can be sure I have given you clear instructions,” or “When you get home your spouse will ask you what the doctor said—what will you tell your spouse?”

From the NNLM's March 2021 Understanding Vaccine Hesitancy webinar, SIFT is an acronym to help users identify and process misinformation.

Stop when you encounter potential misinformation. Even if you decide not to share it, that helps. Sharing (mis)information gives it power.

Investigate the source. Who is sharing the information? Is it a reputable source?

Find better coverage. What are other sources saying about the same event/topic? Use fact-checking sites (a lot of misinformation is already debunked). Reverse-image searches can be very helpful. 

Trace claims to original context. Click through the links to find the original source.

After this, if you're still unsure, DO NOT SHARE THE INFORMATION. Please also consult the links below for additional tips on how to implement SIFT in your classroom, practice, or in everyday life.

Remember that many people who believe misinformation have come by that position because that is the only information they have been exposed to. When their concerns gets dismissed rather than addressed, they feel as though they are not being heard and tend to dig deeper into their position. 

Patients who have become vaccine hesitant, for example, usually have not done so because of a single piece of (mis)information. Likewise, one piece of information will not make them pro-vaccination. Patient-centered care requires respect and responsiveness to patient preferences, needs, and values. Patients (and especially parents of patients) report that they want providers to listen to their concerns and questions. Nudging or coercing patients into getting vaccines ("okay, time for some vaccines") bypasses meaningful patient engagement and leaves patients feeling unheard.

Engaging in shared decision-making helps patients feel involved in their care. "Shared decision-making offers an intermediate alternative for both physician and patient. For the patient it offers some say without total responsibility, and for the physician, an opportunity to go beyond a role of transferring information to also participate in, but not dominate, the decision-making process" (Charles, et al, 1997).

Read more here:

Addressing Vaccine Hesitancy Requires an Ethically Consistent Health Strategy (Williamson, Glaab, 2018)

Shared decision-making in the medical encounter: what does it mean? (Charles, et al, 1997)