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How to handle patient questions over COVID19

“What about coronavirus if I’m trying for a baby?” 

“What does it mean for my fertility treatment?”

“I’m just pregnant! What should I do about the virus?”

Questions like these are now routinely asked by patients. So, what do we say? How do we convey what we know honestly, but rationally and in a way that does not add unduly to the stress that many patients are already experiencing as a result of their situation and treatment?

So, first off, I’m not going to provide a crib sheet of typical questions and model answers. Firstly, every patient is different and, secondly, the situation in terms of our knowledge of the nCoV19 pathogen is rapidly evolving.

Instead, I’ll focus on how serious news is best imparted to people who are under stress. These patients feel threatened by circumstances beyond their control. Although I have some experience in this area, I also spoke to a number of experts. These included a career diplomat, two experts in customer services, and a senior communications manager in a healthcare public service organisation.

I’ve compiled their tactics for answering serious questions while allaying panic at the answers into a list, which I hope is helpful.

  1. Acknowledge the question

Almost everyone I spoke to agreed that, not only is this an important courtesy step, but that in acknowledging the validity of the question it allows the person answering the opportunity to transition to the next smoothly.

Suggested responses from my expert colleagues include:

“A lot of people are asking this, of course, and rightly so.” 

“Good question. I’m glad you asked.” 

“Yes. I was going to bring this up, so thanks for raising it.”

In telling the person that you agree with the validity of the question, and that you are considering it seriously, you set an expectation in the listener’s mind. i.e. that they are about to receive some information that will help them. That expectation puts fear and anxiety on temporary hold, allowing the patient to be more receptive to what you are about to say.

  1. Set the scene for a discussion

This is very important. It allows you to set the parameters of the discussion regarding the question. I say discussion, because everyone agreed with me that this is the best mechanism for answering these kinds of questions.

A discussion is a two-way conversation that allows the patient to ask further questions as the discussion proceeds. It also allows the healthcare professional to check that the patient agrees with the healthcare professional at key points. Answers that shut down a discussion (e.g. one or two sentence statements) will not suffice, and the patient will not be reassured by them.

How might you set the scene to an answer for a question relating to the COVID19?

You might, for instance, build a scene-setting scenario around the following storyline, mixing realism with reassurance:

  • There are limitations to our knowledge of this virus at the moment (realism)
  • This coronoavirus is new, and we do not have immunity to it (realism)
  • Because it is new, we do not have lots of specific previous data about it (realism)
  • But new data is coming in all the time. And although the virus is new, its species is well known. If a new breed of dog comes along, we might not have seen it before, but we still know it’s a dog! (reassurance)
  • What we DO know at the moment (reassurance)
  • The symptoms resemble that of a cold or flu – particularly cough, shortness of breath and fever (realism)
  • Children seem to have milder symptoms than adults (realism and reassurance)
  • But old people and those with underlying health problems seem to be vulnerable to much more serious complications of the infection and this is where the primary danger lies (realism)
  • “So, where does that leave us?” (reassurance, because it introduces into the conversation the concept of the healthcare professional and patient being a team)
  • Repeat the patient question…..(reassurance. i.e. The question is important and we, as a team, are now focussing on it).

In this way you can set the scene for the answer to the patient’s question, reassuring and informing them. It is a helpful strategy because it allows the discussion to take place without hitting angry derailing questions like, “Why don’t you know?”

  1. Gain agreement with the points you make in your scene-setting narrative

This may be just a question of a nod or a smile, but look for agreement or acceptance with the points you raise. And if there is disagreement or a lack of buy-in then explore it, there shouldn’t be because you are being honest and helpful.

  1. Build your specific answers around anchor points

Anchor points are key facts that guide the discussion, e.g. for the question “What about COVID19 and pregnancy?” an anchor point might be:

  • Pregnant women belong in a high-risk group, because their immune systems are in a constant flux. 

The discussion can then centre on precautions that a pregnant woman might take, taking qualified reassurance from official statements.

For example:

  • Given the information we do have, while it would be wise for individuals with confirmed or presumed COVID-19 infection to avoid pregnancy, there appears to be no cause for alarm for those already pregnant.
  • Data is very limited but some studies from China, which was the original epicentre of this virus, have shown that some women who were pregnant in their third trimester did not pass on the virus to their babies when they were born1
  • SARS and MERS, which were similar coronavirus infections, did not show obvious teratogenic capability.
  1. Offer advice

Once the discussion has taken place, and the patient is feeling reassured rather than fearful, advice can be offered. This might be based the current ASRM guidelines2 with regard to coronavirus2 or simple advice on how to avoid infection courtesy of the CDC website.

  1. Develop an action plan

At this stage you and the patient are a team, and attention can be turned to developing a specific agreed action plan for the patient. This could be very simple, such as following CDC guidelines for prevention of COVID19 transmission3. Or it may be more complex, involving issues regarding surrogates or egg freezing. But whatever it is, the patient has to feel that they have left the consultation armed with the wisdom of the healthcare professional, to the best of all knowledge, against the virus and its potential effects on their ART treatment.

And this should be the aim of all clinic staff who encounter fearful patients. Essentially to reduce fear. The greatest fear is of the unknown, and therefore it is up the healthcare professional to make the unknown more known, and therefore less fearful to the patient.

Neil Madden, Editor

The Fertility Hub

References

  1. Chen H GJ, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395(10226): 809-15.
  2. ASRM. 2020. SART and ASRM Issue Advice for Infertility Patients Concerning the Novel Coronavirus (COVID-19). https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/sart-and-asrm-issue-advice-for-infertility-patients-concerning-the-novel-coronavirus-covid-19/
  3. Centres for Disease Control. 2020. Coronavirus – how to protect yourself and others. https://www.cdc.gov/coronavirus/2019-ncov/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2Findex.html