How to help patients overcome the ‘Fear of Finding Out’
Dr Angel Chater, Health Psychologist at the University of Bedfordshire, shares her top tips on how health professionals can support patients and help them better engage with health services.
Have you ever come across a patient who seems disengaged with their health, in particular reticent to seek medical treatment, or act on medical advice? Have you ever met a patient who appears to be lacking in motivation, time, or commitment to make any changes to their lifestyle in order to improve their wellbeing? If you have, you’re not alone, and it can be as frustrating to the patient’s healthcare professional as their family members alike.
However, the underlying cause of this seeming ‘ambivalence’ may be something far more difficult to overcome, it may be what we now know to be the ‘Fear of Finding Out’ (FOFO).
Research has revealed that the ‘Fear of Finding Out’ is in fact one of the main barriers preventing adults from making healthier lifestyle choices. According to a reporti released by think tank 2020health in partnership with AbbVie, the ‘Fear of Finding Out’ makes up nearly a third of all conscious reasons why individuals may be delaying or avoiding seeking medical advice when they may be concerned, or not taking the relevant steps to improve their healthii. The report also discovered that men and those who are single are more likely to postpone seeking medical advice than others.
Fear is often hugely challenging for patients to overcome, so what can you do to help them to engage with health care and ultimately take control of their wellbeing?
Here are some top tips based on a Motivational Interviewing approach that might be useful when trying to help patients who may have the ‘Fear of Finding Out’:
1. Engage: Engaging your patients in conversation is one of the best ways to have a meaningful consultation with them. Building rapport is so important in helping people to feel like they can trust you and importantly, that you are there to listen to them. A good conversation starter which you can use to help your patients open up to you more quickly is: “What is troubling you today?” This open-ended question enables the patient to respond freely to what is troubling them – which can often help get to the root of the problem more quickly.
2. Resist: It may sound counter-intuitive, but resist giving your patient the answers. This is what psychologists call: ‘the righting reflex’. Although a natural part of the job as a nurse or other healthcare professional is to give your patient advice on the importance of getting their health checked out, this could in fact make the patient less open to seeking medical help. This is especially important if your patient does have a ‘Fear of Finding Out’, because they will have a stronger aversion to engaging with health services.
Instead of telling the patient to get a health concern checked out, you can try asking any of the following questions, which might help them to uncover and overcome their fears: “What is currently stopping you from getting a health check?”, “What would finding out about a condition mean for you?” or “What are the benefits of this?” This helps the patient to bring their thoughts out into the open.
3. Focus: Your patient might not even know that they have FOFO; it’s only natural for people to hide fear in the back of their minds as a coping mechanism to avoid addressing it. Someone who does have the ‘Fear of Finding Out’ when it comes to their health may instead present with avoidance issues or behaviours. For example, you may hear them saying, “I don’t have time to go to the doctor”.
So to help your patient focus, you can ask them questions about their priorities in life, for example, “Who relies on you?”. It might be their partner, children, cat or their job. The next question could be: “What would happen if you were no longer here?” or “How would they feel without you?” These types of questions may help your patient to realise why they need to face up to a medical concern.
4. Understand: As a practitioner, you should aim to spend more time listening than speaking, unless important clinical information needs to be delivered. It is important to listen to your patient, to try and understand their circumstances, and then reflect back to them what they are saying to you so that they can hear it for themselves. Whilst this can be challenging when you only have a certain amount of time with a patient, it is still useful to ask open-ended questions, which often start with ‘what’, ‘who’, ‘how’, ‘when’ or ‘where’. This will encourage your patient to talk, enabling you to listen out for vital information to give you the insight needed to best help them.
5. Evoke: In asking open questions, you will be encouraging the patient to cognitively understand their current situation. They may have never been asked these questions before and they are unlikely to have ever asked them to themselves. Therefore, by asking these questions outright, they may be more likely to admit to the true reasons that they are not engaging in health services. This may be a crucial turning point in a patient realising that they have FOFO.
If they do have the ‘Fear of Finding Out’, they may tell you that they are afraid of discovering they are unwell, for fear of not being able to take care of those who rely on them, or fulfill their duties at home, work, or in relationships. They may be concerned of financial implications or a medical procedure. Be a mirror to their internal dialogue, reflect back to them what they say to you.
6. Knowledge and support: Once your patient has opened up about their ‘Fear of Finding Out’, it will be important to understand what they need in order to tackle it. Ask questions that will help you to understand how knowledgeable they are about the health services available to them, the possible condition they may have, and what their support network is like – for example, do they have access to transport or social support if needed. Finally, try to establish what their attitude or self-confidence is like and how motivated they will be to take further medical advice needed. With this insight, you will be able to support them accordingly. As before, the key will be in keeping these questions open-ended.
7. Plan: Help your patient to plan a way forward. Try to help them to understand what they need to do to engage in health services. It will be important to let them lead this conversation which will help them to take responsibility for the decisions they make. This in turn will make them more likely to engage if this motivation is driven by themselves. Again, open-ended questions will be useful in eliciting this information, and you can ask questions such as “What will you do from here?”; “Who can help you?”; “How confident are you that you will do this?”; “How can I support you?”
Dr Angel Chater is collaborating with Live:Lab – an innovative partnership, bringing together the worlds of technology, creativity and healthcare to help people take control of their wellbeing. Her work draws from a Motivational Interviewingiii approach. This article originally appeared in Nursing Standard.
i 2020health: The Fear of Finding Out – Identifying psychological barriers to symptom presentation and diagnosis in the UK. 2017. Available at http://www.2020health.org/2020health
ii Kannan, V. D. & Veazie, P. J. (2014). Predictors of avoiding medical care and reasons for avoidance behavior. Medical Care, 52(4), 336-345
iii Miller, W. R. & Rollnick, S. (2013). Motivational interviewing: Preparing People for Change. 3rd Edition. New York: Guilford Press.