Trust and Communication: Responding to Uncertainty

The COVID-19 pandemic has impacted lives globally and the implications will continue to unfold well into the future. As societies struggle to address racial inequities and health disparities, the emotionally charged suffering rampant in our current political climate heightens the need for humanism and compassion. More than ever, we must emphasize the importance of trust, communication, and relationships as we consider the health care experiences of patients, families, clinicians, and staff.

Trust

Patients and families often struggle with the uncertainties related to personal health and the delivery of care. As the spread of COVID-19 unfolds and scientists continue to rapidly collect and assess data, the lack of conclusive evidence and the shifting recommendations foster a sense of distrust. A recent statement published by international leaders in the field of health communication science aptly emphasized the following:

“marginalized communities are under-represented in science and healthcare, which reduces effectiveness in both composing and disseminating key messages about risk and risk mitigation. These communities understandably have low rates of trust in healthcare systems at baseline, making clear and equitable communication more difficult and even more important. This complexity occurs against a backdrop of collective fear, which influences not only the communication of risk but also its appraisal. Also, exposure to bad news and images of illness and death can increase anxiety and lack of confidence in the possibility of effectively managing the pandemic. One major aspect to consider is the negative impact of misinformation on behavior change by suggesting suboptimal actions or spreading information inconsistent with the views of health institutions”. (1)

Communication

The strain of responding to emerging crises can test the humanism and compassion of even the most skilled communicators. Heightened emotional states threaten the quality of communication encounters for both patients/families and clinicians/staff. Personal protective equipment, social distancing, and telehealth encounters increase the complexity and sense of disconnection. The words we use are increasingly important when we cannot rely on nonverbal cues. Establishing connection in the context of COVID-19 calls us to focus intently on skills to establish rapport, to invite and respond to emotion, and to explain things clearly and succinctly.

Encouragingly, despite the recent difficulties threatening relationships in health care, clinicians and staff have resiliently responded to the challenge. A recent article published Harvard Business Review highlighted upward trends in patient experience scores during the spring months of the 2020 COVID-19 pandemic:

"For example, ratings of the skill of physicians rose 2.4% nationally, 2.8% in Washington and 10.4% in New York. Ratings of nursing rose 2.4%, 2.5%, and 10.4%, respectively. Pain control ratings improved 2.9%, 5.4%, and 12.5%. We saw the same trends across measures of human interactions between patients and their caregivers in the general categories of courtesy, keeping patients informed, personalizing care, responsiveness, and empathy. Nationally, ratings for most of these measures improved by 0.5% to 2% in that month. In Washington, the increases were 2 to 3 times as great, and in New York, 4 to 5 times as great". (2)

In this issue of The Journal of Patient Experience, I am pleased to feature several “Special Collection” submissions reflecting the context of COVID-19 and/or Telehealth. While our collective energy may continue to be influenced by the pandemic, this issue also contains an assortment of patient experience research and perspective articles. As we adapt to a new “normal,” these broader contributions add significant value to our collective knowledge.

My deepest appreciation for your continued dedication toward cultivating improved health care experiences, especially amid uncertain times.

Laura Cooley, PhD Editor-in-Chief, Journal of Patient Experience