Critical care community highlights strategies to improve communication in era of misinformation

A session at the Society of Critical Care Medicine Congress spotlighted the impact of medical misinformation during the COVID-19 pandemic in the ICU, ED, rural areas and on social media.

The impact of medical information is widespread. In the ICU, medical misinformation can result in “false hope for families, loss of trust in the care team, loss of attention to physicians’ words, tension toward the care team and contrasting medical decision-making,” Ashish K. Khanna, MD, FCCP, FASA, FCCM, anesthesiologist, intensivist and associate professor of anesthesiology at Wake Forest Baptist Medical Center in North Carolina, said during a presentation.

As health care providers, “the [COVID-19] pandemic pushed us into a corner. And, actually, because of us being pushed into that corner, we were partly responsible for the misinformation because we had to make early decisions based on whatever was available to us,” Khanna said.

Khanna said it was important to “step in” during the pandemic to combat misinformation circling about COVID-19.

“Over the last 2 years or so, I’ve been talking to our local news media outlet here ... and every month trying to spread as much information that is true and appropriate. ... I really felt gratified that I was able to act as a conduit and liaison and not spread panic but appropriately alert the public and spread and promote appropriate information. That is a responsibility that each and every one of us as critical care doctors have.”

Countermeasures to misinformation

Khanna highlighted several potential countermeasures to misinformation in the ICU, including gently deconstructing alternative truths providing credible “official” data and information; avoiding “fights”; supporting scientific views with data and reliable sources; referencing official resources; conveying to relatives that the care team is needed to provide best care and less suffering to their family member; gently explaining that it is not the idea of a single physician but the entire care team, whose goal is to provide optimal care according to science and ethics.

“Understand, though, that it is very easy for families to feel misinformed in an ICU,” Khanna said. The increasing availability of web-based health information resources should foster intensivists to step out of their comfort zone and encourage families to discuss their online discoveries, Khanna said.

Elizabeth Mahal, MD, emergency medicine and critical care faculty at Nebraska Medical Center at the University of Nebraska, said misinformation has long been an issue in the ED.

“We’ve been dealing with [misinformation] for years. The most obvious example I can think of is patients coming in wanting antibiotics for their viral infections. But COVID-19 has really amplified this in a way we haven’t seen before and I think it’s a contributing factor to burnout for many providers as well.”

Mahal suggested the following strategies: Ensure that you, the physician, are OK and in the right headspace to emotionally engage; listen to the patient/family members to better understand the emotions driving decisions to better reframe the way these facts or ideas are presented; build trust with the patient/family members by being authentic and genuine; be consistent with what you’re saying while tailoring it to the patient and what you’ve learned about them; maintain the impression of being kind, open and always willing to listen.

Medical misinformation in the rural setting

About 60 million Americans reside in rural areas of the country. In these rural areas, there are less than 10% of practicing physicians and there is an approximate 15% reduction in access to primary care providers, Karolyn Fox-Dahl, MD, from the department of anesthesiology and critical care medicine at CHI Health Good Samaritan in Kearney, Nebraska, said during a presentation.

Fox-Dahl referenced data from the Journal of Rural Sociology that compared urban vs. rural counties and characteristics that increase COVID-19 cases and deaths. In this study, “functions of disadvantage, such as lower education level, lower socioeconomic status and lower percentage of non-Hispanic white residents increased both the incidence and rate of [COVID-19] death,” Fox-Dahl said. “However, more conservative political beliefs and increased employment in high-risk industry only were associated with increased incidence and not rate of death.”

Such disparities can lead to misinformation and have affected medical decision-making in rural communities, Fox-Dahl said. Some of the unique challenges faced in rural areas regarding misinformation include a lack of news coverage, lack of health care providers, misinformation from trusted sources and a false sense of security.

Fox-Dahl presented strategies used within the rural ICU to combat medical misinformation, including: engaging administration to open important dialogue and address misinformation; expanding the network to be available to answer questions and provide real-time experience; engaging multidisciplinary nursing and ancillary staff, who have a great impact on patient’s and family member’s knowledge; and preventing burnout and compassion fatigue and improving wellness among health care professionals so they continue to have the energy and motivation to address misinformation.

Medical misinformation and social media

While social media allows for widespread connection and dissemination of information, it is one area where misinformation — and medical misinformation — is easily and widely spread.

According to information from The Pew Research Center, 53% of Americans often or sometimes receive their news from social media, with Facebook being the most-used social media platform for news, as 36% of people reported regularly accessing Facebook for news and 23% reported accessing their news on YouTube, Caitlin C. ten Lohuis, ACNP, critical care nurse practitioner at Emory St. Joseph’s Hospital and Emory Critical Care Center in Atlanta, said during a presentation.

In another study, researchers evaluated 126,000 Twitter news stories from 2006 to 2018 and found that false news was 75% more likely to be spread on social media compared with true news stories. This study also found that humans were more likely to spread false news online compared with robots, ten Lohuis said.

The U.S. Surgeon General built a plan for health care providers to combat medical information, noting that “Health information is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health and undermine public health efforts.”

During the pandemic, trusted community members, such as health care professionals, faith leaders and educators, have spoken directly to their communities to address COVID-19-related questions in an effort to combat misinformation, ten Lohuis said. This has been done on social media and traditional media, as well as town halls and community meetings.

According to the U.S. Surgeon General, doctors, nurses and other providers are highly trusted and can be effective in addressing misinformation. The U.S. Surgeon General’s advisory asks health care professionals to proactively engage with patients and the public on health misinformation; take the time to understand each patient’s knowledge, beliefs and values; listen with empathy and correct misinformation in personalized ways; use less technical language; and promote health literacy on a regular basis.

Health professionals can use technology and media platforms to share accurate health information with the public, ten Lohuis said. They can also partner with community groups and other organizations to prevent and address health misinformation. For example, hospital systems can work with community members to develop localized public health messages, and associations and other health organizations can offer trainings for clinicians on how to address misinformation in ways that account for patients’ diverse needs, concerns, backgrounds and experiences, ten Lohuis said.

“This is a great example that happened in my city: Metro Atlanta health systems came together and addressed the latest on the COVID-19 pandemic. It was also published as a Facebook Live session ... and reposted on Twitter and YouTube,” ten Lohuis said.

Reference:

Sun T, et al. J Rural Health. 2021;doi:10.1111/jrh.12625.