146. Navigating the Infodemic: A Call for Critical Thinking to Optimize Patient Care (CE)

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:13):
- Welcome to this editionof NP Pulse, the voice
of the nurse practitioner.
I'm Cammie Hauser, a nursepractitioner, nurse midwife,
and AANP education specialist.
This podcast brought to youby the American Association
of Nurse Practitioners featuresnurse practitioner voices

(00:35):
and expertise on issuesthat matter most to NPs
and to our patients.
In the second episode ofa three-part series, Dr.
Ruth Carrico and Dr.
Paula Tucker examinedthe growing challenge
of medical misinformation andits impact on patient care.
They explored the infodemic,which is the rapid spread
of both accurate andinaccurate health information,
and emphasize the need foreffective infodemic management

(00:56):
strategies, drawing keylessons from the COVID-19
pandemic. Listeners will gaininsights into best practices
for identifying credible sources,
critically evaluating evidence-basedscientific information,
and addressingmisinformation with patients
through real world experiences
they highlight the roleof cognitive biases,
social determinants of health
and technology in misinformation spread.

(01:17):
While providing actionable strategies
for nurse practitionersto foster patient trust,
enhance communication,
and navigate today's complexhealth information landscape.
- Welcome back to ourpodcast series about medical
misinformation and myths.
This is the second in athree part series podcast.
So if you miss the firstone, our goals today are

(01:38):
to build upon our challenges
and opportunities to impacthealthcare decisions in the era
of misinformation.
The title of this podcast isNavigating the Infodemic,
A Call for Critical Thinkingto Optimize Patient Care.
My name is Dr. Ruth Carrico,
and I'm a family nurse practitioner from

(01:59):
Louisville, Kentucky.
I'm joined again by mycolleague, Dr. Paula Tucker.
Paula, can you share a little bit
of information about yourself
before we dive into ourdiscussion for today?
- Thank you, Ruth, and absolutely.
I am so honored once againto have the opportunity
to co-host this podcastwith you on something

(02:21):
that I believe is a critical discussion.
Again, I'm Dr.
Paula Tucker, and I ama board certified family
and emergency nurse practitioner.
I currently hold a clinicalpractice at a level one trauma
center, and I also have theprivilege of educating nps.
I am a clinical associateprofessor of nursing
and specialty director

(02:41):
of the emergency NP trackat Nell Ho Witches School
of Nursing, Emory University.
And I'm so honored to be here today
to talk on this amazing topic,
and I think we're gonna have a great time.
- I know we will. Thanks so much, Paula.
I learned so much fromyou in the first podcast,
so I hope people that arelistening in on this podcast will
be interested and hear whatthey missed and go back

(03:04):
and listen to that one either before or
after they finishjoining us in our series.
So in that first podcast,
we talked about medical misinformation
and how difficult it can be
to differentiate fact from fiction.
So, you know, as a healthcareprovider, this is something
that I encounter on afairly regular basis.

(03:24):
I would like to say fairly regular,
but it seems like every day,as I either talk with patients
or colleagues, we're focusing on something
that either didn't make senseor was concerning to us,
or maybe providing new information
that changed our perspective.
So I know that in listeningto your experiences,

(03:45):
you have had that same situation too.
I don't really mean thatit only involves medical
misinformation that mypatients will bring to me
and wanna talk about.
I also spend a significant amount
of time reading themedical literature as part
of my own professionalresponsibilities and development.
And that helps me ensurethat I'm up to date on issues

(04:07):
that not only impact my patients,but will help me rethink
and then influence mypractice moving forward.
Sometimes information I'm readingcontains then other pieces
of new info that justdon't seem quite right,
or it may be unclear to me.
So when this happens, it'snot always easy for me to try

(04:28):
to really figure out whatis fact, what is fiction,
or is this erroneous information
or has it been informationthat has been misinterpreted,
or is it accurate in justsomething new for me?
So clearly misinformation is a challenge
to save patient care as well
as just my own ability

(04:49):
to understand the many changes
that are happening in healthcare at large,
and then try to figure outhow do I look at information?
How do I fix problems
that maybe I have unknowingly created
because I was using informationthat wasn't accurate?
Or what happens if I can't fix it?
And I look forward and I'mthinking about, you know,

(05:11):
I'm not sure what todo with this situation.
I've got to maybe correct something
that I talked about previously.
So in our time together,I want us to look at this
and have, how do we fix the problem?
Where are we going with misinformation
or with all of the piece ofinformation now that are part
of our culture?
So to get this started, let metalk a bit about information

(05:36):
and the massive amountswe receive every day
through electronic mediaprint, and even verbal sharing.
When we think about the amount
of information involving health,
it seems like we're really bombarded.
If you're like me, I turn onthe news, I turn on the radio,
I look at my email, Ilook at my cell phone,
I look at a number of thesocial media platforms

(05:58):
that I connect with, and I'mgetting a lot of information.
And many times it's overwhelming.
And in fact, the term infodemic is used
to describe the rapid
and far reaching spread of information.
Now, much of that information is accurate,
but much may also be inaccurate.

(06:20):
And unfortunately, it's alloften impossible, not only
for me, but for I think for all of us
to differentiate true from false.
And many times we useother factors such as who
provided the information,
and that may be a key element that we use
to determine whether or notwe feel like we can believe it

(06:40):
or whether or not we should act on it.
And we all have storiesabout information we receive,
particularly during the COVID-19 pandemic.
When I think about, youknow, medical misinformation
and the information infodemic,
COVID-19 just comesimmediately to the forefront.
I was talking with somebody yesterday

(07:00):
and they reminded me
that we are five years into this pandemic.
So when we look back andwe think, oh my gosh,
our lives really changed.
You know, the first part of 2020,
now we're into this fifthyear, we all have stories
to share about information we received
during the COVID-19 pandemic.
Some was true, some was not true.

(07:22):
Sometimes we were unableto determine what was what
and further complicating the situation.
We know as the pandemic continued
and as information unfolded,as we learned more,
we received new informationthat contradicted
what we previously knew orat least thought was true.

(07:42):
As I talk with my infectiousdiseases colleagues,
my practice the last 35 years
of my career has beenin infectious diseases.
And as I talk with myID colleagues, you know,
the most common themewas, oh my gosh, you know,
this upended ID practice, things
that we thought were absolute truths
regarding infectiousdiseases and transmission

(08:05):
and how microorganisms worked.
All of that was upended
that we were just allstanding on our heads.
We received informationthat contradicted again,
what we previously thought was fact,
and that made it difficultto talk with patients.
But more importantly, it madeit difficult for patients
to believe what we said or to trust us.

(08:29):
And for me, that was reallythe worst part of dealing
with medical misinformationwas either the potential
loss of trust or the actual loss of trust.
Because we know, if we lookback to the Gallup poll, again,
the general public has said
that nursing is themost trusted profession.

(08:53):
So that means nurses are the most trusted
of healthcare professionals.
So the public is gonna cometo us to ask questions,
or they're going to listen to us,
or they're gonna seek our opinion.
And if we lose that trust,that is something tremendous
that can impact us negatively.

(09:14):
So I've spent a lot of timetalking this morning, Paula,
I wanna to get some of your thoughts
and some of yourexperiences, maybe starting
with the COVID-19 pandemic
and what this meant to you asan emergency care provider.
- Wow, thanks, Ruth.
You've certainly highlightedsome great points.
I do wanna start by stating

(09:34):
that misinformation isn't justsomething we encounter from
patients, and I thinkyou've mentioned this.
You know, as healthcare professionals,
we also must navigate anoverwhelming amount of information,
some of which is conflicting,unclear, or even misleading.
And during the COVID-19 pandemic,

(09:55):
this became even more apparent.
You know, working inthe emergency department
during COVID-19 was unlikeanything I had ever experienced.
We weren't just battling the virus,
we were battling misinformation, fear
and mistrust every single day.
And that wasn't just coming from patients,

(10:16):
it was also affecting ourclinical decision making,
our policies,
and our ability to provideconsistent evidence-based care.
And one of the biggest challenges was
that information was constantly changing.
Early on, we were adaptingour treatment protocols
almost weekly.
As new research came out,

(10:37):
what we thought worked onemonth would be questioned
or debunked the next.
For example, I rememberwe were using ventilators
aggressively in COVID-19 patients,
but then we started seeingthat high flow nasal cannula
and proning were moreeffective in many cases.
And so this constant shift inguidelines made it difficult

(10:58):
for patients and even cliniciansto know what to trust.
And in fact, many patients
and the public saw thesechanges as evidence
that healthcare providersdon't know what they're doing
rather than the reality thatscience is an evolving process
that self-corrects as we learn more.

(11:19):
We also found during COVID-19that the rapid evolution
of knowledge is a strengthof medicine, not a weakness,
but it was so hard to convey that
during this particulartime, I can't tell you
how many times I had patientscome in the ER convinced they
already had the cure for COVID-19,

(11:39):
whether it washydroxychloroquine, ivermectin,
or high dose vitamin C, theseweren't just fringe beliefs.
They were widely shared incommunities, social media,
and even by some healthcare providers.
I remember having a patient who presented
with respiratory distressrefusing dexamethasone

(11:59):
because they had heard
that steroids weakened the immune system
and it would make covid worse.
And they insisted on taking anatural alternative they had
seen promoted online.
And so this brings achallenge to providing
that evidence-based care.
How do you respect apatient's autonomy while

(12:20):
also preventing harm?
That was the question.
And the goal was always to listen first,
not immediately dismiss their concerns,
but to redirect withevidence-based education.
So what were my strategiesto this challenge?
I had to acknowledge the concern,
provide clear non-judgmental education,

(12:41):
and encourage trust in reliablesources such as the CDC,
the WHO or NIH.
The hardest part wasn't justseeing critically ill patients,
it was seeing preventable deathsbecause of misinformation.
There were cases where patientsrefused hospitalization
until it was too late

(13:02):
or declined treatments thatcould have saved their lives
because they had been toldsomething different online.
These cases were devastating,not just for families,
but for us as providers.
We weren't just treatingdisease, we were trying
to counteract deeply ingrainedmisinformation in a crisis
situation, misinformationdoesn't just harm

(13:25):
individual patients.
It leads to worse publichealth outcomes increased
healthcare strain and emotionalburnout for providers.
And we definitely experienced that
during the COVID-19 pandemic.
So on the brighter side, you know,
what were the lessonslearned from navigating
misinformation during the pandemic?
And how do we apply theselessons moving forward?

(13:47):
We learned that patientsdon't just need facts,
they need context.
And so we have to explainnot just what we know,
but how we know it andwhy it sometimes changes.
And building trust with our patients
and the public is built through clear,
transparent communication, notjust dumping data. We learned

(14:07):
we must listen first, then correct.
Misinformation is oftenrooted in fear and mistrust.
And instead of immediatecorrection, ask questions
to understand why a patientbelieves what they do.
Then provide an alternativethey feel safe accepting.
During our previous podcast,

(14:28):
I talked a bit about clinician bias.
We assume we are the oneswith the knowledge, right?
But are we open toquestioning our own biases
and staying up to date as science evolves?
Are we willing toreevaluate our beliefs just
as we expect our patients to be?
So I wanna talk a littlebit more about the

(14:49):
nature of the infodemic.
You've done a great jobsetting the stage, Ruth,
and even defining the infodemic,
but I also wanna talk about why it matters
and how we can manage it effectively.
So what is infodemic?
The term infodemic was widely used
during the COVID-19 pandemicto describe the overload

(15:11):
of health relatedinformation, both accurate
and inaccurate, spreadingrapidly through social media,
news outlets, and even withinthe medical community itself.
An infodemic isn't justabout misinformation,
it's about the sheer volumeof data, making it difficult
to separate reliablescience-based information from

(15:34):
misleading or outright false claims.
And so the challenge faced
with an infodemic is whenpeople are overwhelmed
with conflicting information, they tend
to rely on emotional reasoning,their personal biases,
and trust in familiar sourcesrather than objective data.
So for example, during COVID-19,

(15:55):
we saw shifting guidelineson mask, treatment protocols
and vaccine efficacy.
And so this rapid evolution,while it was a sign
of science working, itreally caused people
to question the science leading
to public mistrust in the science.
So COVID-19 also amplifiedmisinformation in ways we had

(16:17):
never seen before.
The combination of a newdisease, evolving science,
political influences
and social media algorithmscreated the perfect storm
for medical myths to take hold.
So how did this actually happen?
So I mentioned we hadrapidly changing guidelines,
which made science look uncertain.

(16:37):
There was mistrust inhealthcare institutions
that had increased.
We had a surge of non-experts,celebrities, influencers,
and even politicians
that became dominantvoices in the conversation.
And then social mediacreated these echo chambers
where misinformation spread unchecked.
One of the biggest lessonsfrom the pandemic was

(16:58):
how existing social determinantsof health fueled the spread
of misinformation
and worsened health outcomesfor marginalized communities.
The COVID-19 pandemic didn'tjust expose weaknesses in our
healthcare system.
It magnified the deep seated inequities
that already existed.
And when we talk about misinformation,

(17:21):
we can't ignore the fact
that it disproportionatelyaffects the very communities
that already face thegreatest barriers to care.
Misinformation doesn'tspread in isolation,
it spreads within socialand economic context.
People aren't just rejectingevidence-based medicine
because they want to.

(17:42):
They're often respondingto the gaps in access,
the gaps in education,their lack of trust,
and even their lived experience
within the healthcare system.
That's why understandingthe social determinants
of health is critical to tacklingthe infodemic effectively.
So let's take a closer look at how each
of the five key social determinants

(18:03):
of health domains playeda role in the spread
of misinformation
and why addressing thesedeterminants is essential
to restoring trust in public health.
Starting out with economic stability,
economic instabilitylimits healthcare access,
and pushes individualstowards misinformation driven
solutions that appearmore financially feasible.

(18:26):
So individuals with lowerincome levels were often forced
to prioritize affordabilityover accuracy when it came
to health decisions.
And so this led many to seekout unverified treatments
and distrust expensivemedical interventions.
So for example, financialinsecurity led people
to seek alternative treatmentsrather than FDA approved

(18:48):
treatments that require aprescription or hospitalization.
Moving into education access,lower levels of education,
and specifically limited health literacy,
increase susceptibility to misinformation
because patients lack the tools
to critically evaluate the medical claims.
And we saw this played outin many ways where people

(19:11):
with lower health literacystruggled to differentiate
between a credible source
and misinformation,
many misinterpreted scientificuncertainties as a form
of deception, which ledto vaccine hesitancy
and distrust in publichealth recommendations.
Now as we talk abouthealthcare access, you know,

(19:33):
we've had a historyof medical mistreatment
and barriers to care,which led many individuals,
particularly in marginalizedcommunities, to turn
to alternative sources ofhealth information instead
of clinicians.
And this stemmed from thehistorical medical abuses,
like the notoriousTuskegee Syphilis study,

(19:53):
and particularly within black
and indigenous communitieswhere they distrusted vaccines
and public health officials.
Another example is the unequaltreatment in healthcare
settings reinforced skepticism,especially among patients
who felt dismissed orunheard by their providers.

(20:13):
So as we move into the neighborhood
and built environment wheresomeone lives certainly affects
how easily they can accesstrusted healthcare professionals.
And when healthcare accessis limited, patients may turn
to online sources, their social circles
or alternative medicine instead.
And during COVID-19, rural communities

(20:33):
and urban healthcaredeserts had limited access
to vaccination sites, making it easier
to believe misinformation than
to access trusted medical care.
Patients without reliabletransportation or broadband
Internet really struggledto get factual up
to date health guidance.
And in many areas,social media influencers

(20:54):
and non-medical communityleaders became the primary source
of health information.
And then we have the socialand community context.
You know, culturalnorms, family traditions,
and who people trust intheir community really shaped
what they believe abouthealthcare and medicine.
And we saw that vaccinehesitancy was shaped

(21:15):
by cultural narratives
and religious beliefsrather than just science.
And communities thathad a real strong push
for anti-governmentsentiment were more likely
to reject public healthguidelines as a form
of control rather than protection.
And so medical informationis not just about facts,

(21:35):
it's about trust, cultureand social identity.
Community engagement effortsmust respect cultural
perspectives while providingaccurate health information.
Misinformation doesn't just spread
because of what people believe.
It spreads because of where people live,
what resources they haveand whom they trust.

(21:57):
I do wanna talk a littlebit about the etiologies
and detrimental consequencesof medical information.
So now that we've kind ofexplored how social determinants
of health fuel misinformation,let's take a step back
and examine why misinformationspreads in the first place.
And I think it's importantto understand the etiology

(22:18):
or the root causes, which is critical
to developing strategiesto combat it effectively.
Misinformation doesn'tjust appear out of nowhere.
It arises from a combinationof psychological, social,
technological, andsystemic factors that shape
how people interpret andshare health information.

(22:39):
So let's break down the key drivers
of medical misinformation.
On our first podcast, we spent a lot
of time discussing cognitive biases,
those mental shortcuts our brains take
that can sometimes lead usto believe misinformation.
We explored our biaseslike confirmation bias,
authority bias,
and the Duning Kruger effectshaped the way both patients

(23:03):
and clinicians interprethealth information.
But while cognitive biases area key reason misinformation
spreads, there are onlyone part of the picture.
Misinformation isn't just a matter of
how individuals process information,
it's also about the environmentin which they receive it,
the social and culturalforces that are at play,

(23:26):
and the technological systems
that amplify certain messageswhile suppressing others.
A significant driver
of medical misinformation istechnology, especially the rise
of digital platforms, search engines,
and algorithm driven content.
The internet has revolutionized access
to health information,empowering individuals

(23:48):
to research theirconditions, their treatments
and wellness strategies like never before.
But at the same time, thisunprecedented access comes
with major risk,including the rapid spread
of misinformation.
Social media has acceleratedthe spread of misinformation,
often making false claimsgo viral faster than

(24:09):
factual corrections.
Let's face it. Content thattriggers strong emotions such
as fear, outrage, or excitementgets more engagement.
Social media also creates bubbles
where people only see information
that confirms their existing beliefs.
Cognitive bias platformslike Facebook, TikTok,
and YouTube use algorithmsto prioritize content

(24:34):
that matches a user's past behavior.
For example, if a person interacts
with one anti-vaccinepost, they are more likely
to be fed similar content,reinforcing their beliefs
and making them less likely to engage
with accurate medical information.
You know, one of the mostconcerning technological factors
in medical misinformationis the way search engines

(24:56):
prioritize content.
So just because somethingappears at the top
of a Google search doesn'tmean it's accurate.
And one example is searchengine optimization
or SEO, which allows misinformation sites
to rank higher than credible sources.
There's also this click bait headlines
and misleading metadescriptions, which are designed

(25:19):
to attract more trafficeven if the content lacks
scientific validity.
So what if a patient searches?
Does the flu shot weaken my immune system?
They may see blogs
and alternative medicinewebsites that appear
before they see CDC or NIH links.
And so there we have the AIgenerated health misinformation.

(25:42):
So we have this rise of AI chat box
and large language models.
We now have tools thatcan generate convincing
but inaccurate medical advice at scale.
Chatbots can actuallyhallucinate generating misleading
or incorrect medical recommendations.
AI has also exploited tocreate fake research articles

(26:02):
or manipulate data to legitimizepseudoscientific claims.
And then of course, the rise
of unqualified health influencers.
Social media has giveneveryone a platform,
but not everyone has the expertise
to provide sound medical advice.
Influencers without medicaltraining often spread
misinformation under theguise of personal experience

(26:25):
or alternative health insights.
But many of these figures have millions
of followers giving themmore reach than licensed
health professionals.
So why does all this matter?
What happens when misinformationis believed, acted upon
and spreads unchecked?
What are the real world consequences

(26:45):
for patients healthcare systems
and the public health as a whole?
The impact of medical informationisn't just theoretical.
It has led to treatmentdelays, poor health outcomes,
and even preventable deaths.
And the most immediate consequence
of medical misinformationis the impact on individual
patient decision making.

(27:06):
When patients base theirhealthcare choices on false,
misleading, or incomplete information,
the result is oftendelayed treatment, refusal
of evidence-based care,or reliance on ineffective
and sometimes harmful alternatives.
And patients who believemisinformation about treatments,
vaccines, or medications may postpone

(27:27):
or even reject necessary care leading
to worse health outcomes.
Additionally, misinformationoften promotes non-evidence
based interventions leadingto adverse health effects
and hospitalizations due to complications.
So the impact ofmisinformation extends far
beyond the individualand clinical setting.

(27:49):
It influences public health efforts,
it influences policymaking andpopulation health outcomes.
And one of the most visible
and dangerous effects ofmisinformation has been the rise
of vaccine hesitancy
and the resurgence ofpreventable diseases.
So now that we've exploredthe roots of misinformation,

(28:09):
like cognitive biases, social influences,
digital amplification,
and emotional manipulation,I want us to turn our focus
to solutions now, whichbrings me to my next point.
How can we as healthcareproviders mitigate the impact
of misinformation
and ensure that our patients have access
to high qualityevidence-based information?

(28:32):
The National Academies
of Science in a consensusstudy report, understanding
and addressing misinformationabout science provides a
wealth of information
and strategies for increasingvisibility of credible science
and fostering a more informedhealth literate public.
So I wanna share four principle domains
of infodemic management.

(28:52):
Number one, listening.
Before correcting misinformation, we have
to understand why people believe it.
So it's important that we askopen-ended questions like,
where did you hear that?
What concerns do you have
a patient hesitant aboutvaccines might not just be
misinformed, they may havehad a past negative experience

(29:14):
with the healthcare system.
So it's important that welisten first, correct second,
and then misinformationthen thrives in mistrust.
So it's important that we build rapport
before delivering facts.
Number two, promotingeducation and communicating.
We need to control the narrative instead

(29:35):
of letting misinformationspread unchecked.
So use simple culturally relevantmessaging that is tailored
to different literacy levels.
We have to be intentional about engaging
and connecting withpatients where they are.
The way we communicateinformation matters just as much
as the information itself.

(29:55):
And then number three, building resilience
to misinformation.
Teach patients how toevaluate sources instead
of just telling them what's false.
Encourage critical thinking skills.
Empower patients torecognize the hallmarks
of misinformation.
And ask questions such as, who wrote this?
What's the evidence?

(30:16):
And what is the rationalebehind the information?
Instead of saying,well, that's false, say,
let's break this down together.
And then for engaging
and empowering communities,involve community leaders,
healthcare workers and educators,
and public health efforts,partner with faith-based groups,
schools, and social organizations

(30:37):
to spread evidence, information.
And again, we must meet peoplewhere they are literally
and figuratively.
So some key factors to consider
an EMIC management is health literacy.
We can't assume everypatient has the skills
to evaluate medical claims.
Implicit bias.
Are we dismissing patientconcerns too quickly?

(30:59):
Are we meeting them withrespect and understanding?
And then equity focusedmessaging address the systemic
barriers, instead just blaming individuals
for misinformation.
So Ruth, I've spent a lot of time talking.
We've outlined what an infodemic is,
how misinformation spreads,
and how we can start managing it.
But that brings us to aneven bigger challenge.

(31:22):
How do we as clinicians ensure
that we're using thebest available scientific
evidence ourselves?
How do we find
and critically evaluatemedical research in a world
overflowing with information?
I know you have somegreat insights on this.
I'm gonna turn it backover to you now, Ruth,
- Paula, I've loved listening to you
and the depth of knowledge,

(31:44):
but more importantly,your ability to apply that
and make this real
and pragmatic as we provide patient care.
And a few key points
that I take away from youreally involves the need
for nurse practitioners to recognize
that our patients are startingat very different points.
Not even the same patient isstarting at a very different

(32:06):
point from where they were previously,
but every new patient we see,it is part of our discovery of
how to establish thatrelationship with them,
where we listen and wedetermine where they are.
And then that's when we startour conversations with them.
So you know, their information needs
and fears may take longerto address than we expect.

(32:28):
And so that challengeseverything from the basics
of our schedules.
You know, trying to get through
and see all the patients thatwe are going to see at a time,
but really rethinking, you know,
how do we engage others in our practice
to help us address these issues. Equally,
recognizing that we have ourown biases with respect to

(32:50):
what we know or what we think we know.
And I think, you know, what also makes
that even more difficultis that we have to realize
that everything we need toknow about a given topic hasn't
yet been unveiled, hasn'tyet been discovered.
So information is gonna constantly change.
So we can't be wedded towhat we have always done,

(33:12):
what we've always known, andthat we have to take time
and examine whether or not we are ready
and able to change wheninformation changes.
So what we consider to be fact,
or the way we've alwaysdone things is going
to continue to change.
We have ourselves beenimpacted by misinformation,

(33:34):
so we have to remain open to questioning
and reexamining our knowledge base.
I think that is a key thing for me,
and that I've gotta continue to learn.
I've gotta continue to focuson how am I gonna apply that
and how am I gonna continueto change my practice
to do my best work.
Now you also shared information about some
of the consequences of misinformation

(33:57):
and the tremendous impacton health and trust,
and some initial thoughtsabout how we can begin
to manage the massive amountsof information that can
and do influence us,
and how we need to use thatto manage the infodemic.
Now I wanna add to that andtalk a bit about practices we
might use for finding

(34:19):
and critically evaluatingsolid information
and evidence-based scientific information.
So I think first, whenI think about, you know,
how do I pick, what do Iread, what do I digest?
What do I begin to use
and think, how doesthis change my practice?
I've gotta consider the source.
Now that's sometimes readily apparent,

(34:40):
but other times it takes abit of effort to identify
that source as well as the purpose
of the information shared.
Now, in the past, Iconsidered publications
as highly reliable withrespect to scientific rigor
and accuracy.
Well, unfortunately now wehave a number of journals
that are available to us,

(35:00):
but the review processesthose journals use may not be
as rigorous as what is needed.
So you know, I open up anonline journal, I'm using
that information to reassess, reevaluate
what I am thinking, what I'm using.
And that may be a problem for me
because even in a journal, something
that we have relied upon,

(35:21):
there may be medical misinformation.
In addition, we've experienced situations
where science may not have been accepted
because it differed fromwhat was currently considered
to be conventional wisdom.
So that means we have hadthen a number of scientists
that have said, Hey, I have athought, I have some evidence,

(35:44):
but I can't get it published
because it differs from where we feel safe
and secure in our information.
So that just kind of brings to point that
as we have had new treatments
or new modalities, new thought processes,
if it's different fromwhat we have always used,

(36:05):
it may automatically be disregarded.
That may or may not be the case.
And I think as we learn more,as we gain more from science,
and again, you know, Ithink it's important for us
to remember that if wetruly trust science,
we are not going to be concerned
with having any study validated.

(36:26):
And in fact, as professionals,
we don't mind have our own practices
or our own knowledge validated
because we know thingschange, science changes,
new knowledge is brought tothe universe for us to use
as part of our focus.
Now we have a difficulty in

(36:47):
where we may be currentlyexperiencing information
in the literature,
and it's pressed me really tofocus principally on journals
that I've trusted in thepast and try to keep an open,
but a speculative mindwhen reading others.
I don't know that there'sany magic answer to that.
And I think, you know, some of it comes

(37:08):
with experience in reading the literature,
gaining then more trust in my ability
to understand study design,
and am I using some
of those basic principleswe learned very early
on in our careers?
How do we assess and evaluatethe medical literature?
I would love to say thathas become easier for me

(37:29):
as I have gained more experience.
I don't know whetherit's really become easier
or whether it has becomemore apparent to me
that this is an area whereI constantly have to learn.
I constantly have to try to get better.
Now, we've talked previously about
how misinformation can emerge,
and that was the misinformationsimply as a result

(37:50):
of misunderstanding of the information,
or was the information wrong
and purposefully pushed forward?
That too can be verydifficult to determine.
So when we identify informationwe feel is important
for our purposes, maybethere are a few tips
that we can use in assessing.

(38:11):
Now. First, what I do, I look at
what is the origin of the information?
Maybe something clear like whopaid for it, who is kind of
underneath or behind the pushing forward.
Is it a group I can trust?
It is a group where I realize
that maybe there are aretwo sides to the story,
but there may be aheavier weight on one side

(38:32):
of the story versus the other.
I need to know that I needto have my eyes wide open
and look for that transparency in making
that determination about, youknow, how well can I trust
or do I need to trust
yet verify was the baseline study biased
and was that information disclosed?

(38:52):
And I think then that reallypresses forward that many
of us then that areincreasingly coming forward
and being asked maybethrough our own local media
or other organizations,you know, asking for us
to talk about our experiencesor use our knowledge.
We also have to be very transparent in

(39:14):
where our biases lie.
And any disclosures that we have,
whether they're financial disclosures,
whether they are informationdisclosures, you know, we have
to realize that that is important
and that can be a verystrong basis for whether
or not our patients orour communities trust us.
So, you know, a, a goodexample I think is,

(39:37):
is when we think aboutmisinformation, is drug information,
was this information providedby the pharmaceutical company?
And if it was, and it's notbad if that information is
provided, that information,the studies have been funded
by the pharmaceutical industry,they have been carried out
by groups that have notbeen biased by that company.

(40:00):
The information belongsto that clinical trial,
that clinical study, itgoes then to the FDA.
So there are process to protect that,
but it is important for thoseof us that are reading that
and using it, we need to make sure
that those biases wereappropriately disclosed.
Now, once we're able to determinebiases that are associated

(40:21):
with the information, thenwe look at the quality.
Is it appropriately referenced?
Is the information thatwas used to reinforce
or to strengthen the background?
Is it current? Now, we may think
that publications within theprior few years be relied upon
to be current and haveup-to-date information,

(40:42):
but we all realize howquickly research occurs.
And now, as you mentionedwith artificial intelligence,
clinical guidelines may have access
to research outcomes at a faster pace.
So AI may be influencingthen our clinical guidelines,
our systematic reviews, our meta analysis.

(41:02):
So although that many ofus realize the benefits
of artificial intelligence,as you brought out,
there is a double edge to every sword.
So there always two sides.
So we have to gain expertisein looking at the use
of AI, and this means that weneed to be getting involved.
And so that we understand,are we using ChatGPT,

(41:26):
do we understand
and have we used some practical areas
to help us gain insight?
Are we using then some examples to help us learn about AI?
So we can see
and clearly identifywhere this is a problem
and where it is beneficial.
So something that kind of usesour own contextual background

(41:47):
to help us realize what those benefits are
and what those risks are.
So it just introduces then that as part
of our own professional developmentas a nurse practitioner,
not only are we having
to learn about theclinical course in care,

(42:08):
but we're having to learn about
where is the information available to us
that is influencing us,and how reliable is it?
What are those risks?What are those benefits?
What do I need to spendtime then in learning about?
It's not only about thehealthcare literature,
it's about the source ofinformation itself that I need

(42:28):
to be spending time andbe broadening my horizons.
So Paula, I, I wanna kindof turn it back to you
and get some of yourthoughts about finding
and evaluating evidence-based information.
We talked about dynamism, wetalked about, you know, the,
the dynamic nature of information.

(42:50):
Can I learn more from youabout some of your experiences?
- Absolutely. That's agreat question, Ruth,
because at the heart of combatingmisinformation is ensuring
that we as clinicians, academicians,
and the public know how to identify
and assess credibleevidence-based information.

(43:11):
I think it's important thatwe first define what we mean
by evidence-based information, right?
So in medicine this meansthat information we rely on,
whether for clinical decision making,
public health recommendations,
or even patient education,
is rooted in rigorous scientific research
through peer reviewed studies

(43:32):
and even consensus fromexperts in the field.
And so this is where the concept
of evidence hierarchies come into play.
Not all evidence is createdequal, right at the top
of the hierarchy.
We have systematic reviews
and meta-analysis,
which synthesize findingsfrom multiple studies
to provide a comprehensiveunderstanding of a topic.

(43:56):
Then we move down torandomized control trials,
observational studies, expertguidelines, and case reports.
And at the bottom of that hierarchy are
what we call anecdotes, opinions,
and non-peer-reviewed sources.
So when we talk about evaluatinghealth information, we have
to ask, where does thisinformation fall on the

(44:18):
evidence hierarchy?
Has it been validated throughrigorous scientific review?
And importantly, who isbehind the information?
So a commonly used tool
and simple way to assess the credibility
of health information isthe CRAAP test, which stands
for currency, relevance,authority, accuracy, and purpose.

(44:39):
So number one, currency isthe information up to date.
So medical science evolves quickly
and recommendations changeas new evidence emerges.
So we have to make surethe evidence is up to date.
Relevance, does the information apply
to the specific clinical question
or patient population inquestion, how relevant is it?

(45:01):
Number three, authority,who is the source?
Is the information comingfrom a reputable medical
institution, a governmentagency, or a peer review journal?
Or is it a personal blogor social media influencer?
Number four, accuracy.
Is the claim backed by data studies

(45:21):
and scientific consensus,or is it anecdotal evidence
or based on a single flawed study?
And then five, purpose.
What's the intent behind the information?
Is it to educate, inform,and improve health outcomes?
Or as you mentioned, is someonetrying to sell a product,
push an agenda, or provoke fear?

(45:43):
So we often hear from thosepromoting misinformation.
Well, there are studiesthat say otherwise.
And while that may betrue, we must remember
that science is not about cherrypicking individual studies,
it's about the weight of the evidence.
So a single study doesnot make something true.

(46:03):
Science builds over timethrough replication, peer review
and expert analysis.
And that's why major healthorganizations such as the CDC,
the WHO and FDA rely onlarge scale data analysis
and consensus from multiple experts
before making public recommendations.
So when evaluatingevidence, it's important

(46:24):
to look at the total body
of research rather thanfocusing on one outlier study
or a sensational claim.
You know, one of the mostimportant things we can teach both
patients and providers isthat science is not static.
It evolves,
and this is why medicalrecommendations change over time,
not because healthcare professionals

(46:46):
or doctors don't know whatthey're talking about, but
because we are constantlylearning and improving.
So when evaluating medical claims,
the key takeaway is trust theprocess of scientific inquiry.
Look for large scale peerreviewed, consensus driven data,
ask the right questions,
and most importantly, always be willing

(47:07):
to update your understandingas new evidence emerges.
You know, Ruth I'm thinking about, you know,
we've had a great conversationaround the challenges.
We've talked about, youknow, some best practices
and evaluating evidenceand, and information.
Let's now change the flow here
and talk about nurse practitioners
and how we are positioned toimplement these strategies.

(47:31):
Do you have some thoughts about that?
- Yeah, I do. And you know, I,
I live in a very pragmaticworld where I try to figure out
how do I take what I learnand what I know and apply it.
It's almost like the, “sowhat” about what we do?
And I think there are twoissues that I wanna mention.
Number one is the criticalimportance of dialogue

(47:54):
among and between nursepractitioners that we, I think,
are getting a social message now
that we can't disagree and discuss.
But I think those of usthat live in the world
of practice know thatwe can and that we must.
So bringing questions about patient care,

(48:14):
bringing questions about
what we have read intonetworking opportunities
where we can listen towhat others are saying.
We can ask questions, we canagree, or we can disagree,
but we have to do so ina professional way so
that I'm learning from you, Iwanna hear what you're saying,
I may or may not agree with you,

(48:36):
but I wanna hear what you'resaying and I need to be open
because you know what, you might be right
and I might be wrong,
and I need to be willingto listen to that.
So having that dialogue,I think is critical.
The second is usingnetworking opportunities,
because if we're going tobe influenced by media,

(48:57):
by misinformation, I needto be able to come together
with my peers
and learn from each other's experiences.
So, you know, I think takeadvantage of our meetings,
you know, when we can come together
and really maximize thesenetworking opportunities.
And not so much even to have social time,

(49:17):
although I don't wannaunderscore the importance
of just having some downtime social time,
but more importantly, to usethese meeting opportunities
to ask a question.
This is something that I read.
Did I understand it correctly?
This is something that Iexperienced, this was my approach.
What do you think? And usethen this collective wisdom

(49:39):
that is present in ourprofession to help us listen
and learn together.
Because I know that I don'talways have a static strength
in evaluating the medical literature.
I wanna kinda keep goingback to this because I think
although it's somethingthat we learned in school,
we learned, you know, some ofus learned it a long time ago.

(50:01):
Some of us have more recentinformation and knowledge,
but it's something that willcontinue to improve over time.
You mentioned in thathierarchy about what pieces
of information can wefeel we can trust more,
those systematic reviews,the meta analysis,
then moving on down to randomizedcontrol, clinical trials.

(50:24):
But unfortunately, whatdo we hear the most
of it is an opinion, and it may
or may not be self-proclaimed expert,
or it may truly be an expertthat I need to be listening to
how they have synthesizedthis information that tends
to be the person that isin front of me the most.
So how do I learn to maybeshield myself for one

(50:47):
of a better word, or protectmyself from undue influence?
That may be a very charismaticspeaker, it may be somebody
that looks very good,somebody that I wanna trust
and believe, but thatmay not be the truth.
So I've gotta, you know, learn.
How do I live in this world of access,
of credible information,access to information

(51:07):
that isn't so credible?
How do I learn to discern the differences,
but importantly, how doI go back to my peers?
So when I think about, you know,
how well nursepractitioners are positioned
to implement practices,those key practices
that you mentioned in infodemicmanagement, how am I listening?

(51:28):
How am I communicating?
How am I educating, how am Ibuilding my own resilience?
How am I engaging with others
and using that engagement to empower me
and in turn empower mypatients to make a credible
and long lasting, impactfuldecisions about their health?

(51:51):
It's not easy, is it?
I'm almost exhaustedin, in going through and
and spending our time togetherand thinking about this,
but I know that there iscertainly a lot to learn.
So let me turn it back to you
and get more of your thoughts about
how do we validate, how do wequestion, how do we deal with
and maybe some go-tosources that you have.

(52:11):
- Absolutely. You know,
nurse practitioners certainlyplay a crucial role,
not just in treating patients,
but ensuring that crediblescience-based information is
reaching the communities that we serve.
I believe nurse practitionersare uniquely positioned
to address misinformation
and how we approachevaluating medical literature
and how we can integratethese skills into professional

(52:34):
development and patient education.
Why do I believe this?
Well, as I previouslydiscussed, the four key domains
of infodemic management.
NPs certainly demonstratecapacity to listen
and promote education.
Yes, we are resilient and knowhow to engage our patients.
We are trained to take apatient-centered holistic approach

(52:56):
that facilitates active listening
and validate patient concerns,which includes understanding
where patients gettheir health information
and why they trust certain sources.
We know that correctingmisinformation isn't just about
providing the facts.
It's about firstunderstanding the patient's
concerns and values.
Nurse practitioners also serve

(53:17):
as trusted healthcare providers
and educators in their community, whether
that is in clinics, hospitals, schools,
or public health settings.
We know that health information needs
to be presented in a way thatis digestible, relatable,
and relevant to diversepatient populations.
And so we have the skillsto tailor communication

(53:38):
that is based on patient literacy levels.
We know how to use simple, clear language
and avoid medical jargon.
Furthermore, NPs
or nurse practitioners have a reputation
for building long-termrelationships with patients,
providing us the opportunity
to help patients developthose critical thinking
skills over time.

(53:58):
Yes, we are uniquelypositioned to meet patients
where they are literally,we work everywhere,
primary care emergency
and acute care, specialtyclinics, community health centers,
telemedicine andunderserved areas, NPs serve
as connectors.
We bridge the gap betweenclinical practice guidelines

(54:20):
and public understandings.
We know how to engage local leaders
and organizations to disseminateaccurate health information
and advocate for healthliteracy initiatives
within communities.
Now this brings us to a big question.
Are NPs well-trained inevaluating medical literature?
And the answer is, well, it depends.
While we are trained inevidence-based practice

(54:42):
and critical appraisal of research,
this skill varies basedon educational preparation
and background, our clinical experience,
even ongoing professional development.
And I believe NPs certainlyexcel in evaluating evidence.
We're trained in applyingevidence-based practice.
We integrate researchinto the practice setting

(55:03):
through clinical decision making.
We are taught to critiqueresearch studies.
We understand study designbias and statistical relevance,
and we even take a holisticapproach to patient care
that considers both clinical guidelines
and individual patient needs.
Now, on the other hand,
not all NPs receiveextensive research training.

(55:24):
Some programs focus heavilyon clinical practice,
but have less emphasis onadvanced research methodologies.
So it's important that westay current with literature,
which really requires a dedicated effort.
Medical research is constantly evolving
and without structuredprofessional development,
it's easy to fall behind.

(55:45):
A lot of NPs rely on clinicalexperience over time.
I know I do. While experience is valuable,
it should compliment, notreplace scientific evidence.
And this is where professionaldevelopment is critical
to our growth as a profession.
For example, integratingjournal clubs into NP practice
settings, offering continuing education

(56:08):
that is focused on research literacy,
encouraging mentorship.
You talked about having that dialogue
and connecting with our fellow NPs.
This is what's reallygoing to bridge the gap
between experienced researchersand practicing clinicians.
And I really like the ideaof creating evidence-based,
practice focused CE coursesthat teach nurse practitioners

(56:29):
how to critically appraise research
and apply findings in clinical settings.
I believe it is also important
that we participate inresearch initiatives,
engage in policy discussions,
and inter-professionalcollaboration are just a few
opportunities to buildcapacity in this area.
I know we're about to wrap it up,
but I think it's importantthat, you know, we talk about

(56:52):
how do we apply theseprinciples and practice,
and as I mentioned before, youknow, assessing the source.
You know, is it peer reviewed journal
or reputable health organization?
Trusted sources like the CDC, WHO,
the FDA, NIH.
When we're looking at Cochrane reviews
and JAMA, New England Journal of Medicine
for clinical research

(57:13):
and for evidence searches, agreat search tool is PubMed
and Google Scholar.
Check for consensus.
You know, does this claim alignwith established guidelines?
We have to look at systematic reviews
and meta-analysis, notjust at one single study.
And then evaluate study design.
Is it randomized controltrial or is it anecdotal?
You know, what were theconflicts of interest?

(57:35):
You mentioned disclosures,any industry funding.
And then also considerpatient health literacy.
How can this informationbe translated into clear,
understandable language for patients?
And so that means we haveto take the next step
and provide patient friendlyresources like Medline,
UpToDate, patient pages,and the Mayo Clinic.

(57:55):
I think there are severaltrusted peer reviewed sources
that adhere to rigorous scientificstandards, particularly,
you know, the CDC, the WHO,
the United States PreventiveServices Task Force also
provides evidence-basedpreventive care guidelines.
We talk a lot about medicalresearch and literature reviews
and the different websites,

(58:16):
but also wanna talk aboutclinical decision support tools
like Up To Date, DynaMed, BMJ Best Practice.
These are tools that we canuse when evaluating medical
evidence, whenevaluating information.
These certainly willhelp us in our practice.
And then also, what about for our patient?
What are some trusted healthinformation for patients?

(58:38):
We have Medline Plus,
which is an excellent patientfriendly medical information.
Mayo Clinic patienteducation, easy to read,
evidence-based health information.
And the Cleveland ClinicHealth Essentials,
which are trusted explanations
for common health concernsin terms of vaccine
and public health information.
We have the CDC’s vaccineinformation for patients, printable,

(58:59):
easy to understand vaccine guides.
Immunization Action Coalitionalso has educational materials
that are specifically on vaccines.
And then we can't forget aboutchronic disease management
and preventive health.
The American Diabetes Association,
the American Heart Association,
the National Cancer Institute,all are trusted resources

(59:20):
that patients can certainly leverage
and we can direct themto these sources as well.
So if a patient asksabout a new medication
or a condition, directthem to these sources.
If they have vaccine hesitancy,provide CDC fact sheets
and plain language.
If they have a chroniccondition, refer them
to the American Diabetes Association

(59:41):
or the Heart Association.
You know, it's not justabout giving patients good
resources, it's alsoabout teaching them how
to critically evaluatethese claims on their own.
So check the resource,look for the evidence.
Beware of “miracle cures.”
Ask the provider if theystill have questions,
because at the end ofthe day, our goal as NPs

(01:00:02):
and educators is to create a culture
of evidence-based healthcarewhere both clinicians
and patients have access
to accurate science-based information.
And by relying on trusted resources,
promoting health literacy,
and teaching critical thinking,
we can help counter misinformation
and ensure better healthoutcomes for our patients.

(01:00:24):
I'm gonna turn it backover to you now, Ruth.
- You know, I, I love the, the fact
that you mentionedresilience earlier because
after listening to this
and really seeing what wehave to do in our profession
and in our personal development,
and helping us reallyrealize the critical nature
of our work that we arethrough our efforts,

(01:00:46):
protecting patients, protecting families,
protecting communities,protecting ourselves.
And that is gonna requirea lot of intentional work,
maybe even more than wehave anticipated previously,
that's gonna require someattention to ourselves,
to our own abilities, tobe resilient in our methods

(01:01:07):
and in our practice,
and then help that translateto resilience for our patients.
So thank you so much.
As usual, I love tohear what you have to say.
I learned so much from you.
I can hardly wait to takesome of what you've said
and put it into practicein, in my own activities.
And I look forward thento our next podcast.

(01:01:29):
Our podcast number three inthis series is gonna focus on
practical tips, again fordebunking medical myths.
And we're gonna choose our battles.
We're gonna talk about
how we implement somepatient-centric communication
techniques and make itagain, all about our patient.
How do we take what we know, what we learn
and improve our patients' livesand their health outcomes.

(01:01:52):
So thanks so much Paula.
It was an absolutedelight again to be able
to spend time with you.
And I look forward to working
with you on podcast number three.
Thank you very much and thanks to AANP for enabling this
to occur.
- Ruth and Paula,
thank you for another
excellent podcast.
To our listeners, thankyou for visiting NP Pulse.

(01:02:14):
This program and the accompanyingclinical tool were made
possible by a medicaleducation grant from Kenvue.
To claim credit for this program,
log into the CE centerat aanp.org/cecenter.
Search for this program byname and complete the posttest
and evaluation by enteringthe participation code Myth25-2
That's M YT H 2 5 - 2.

(01:02:36):
Continuing education creditfor this program may be claimed
through May 31st, 2026.
If you've not already, please be sure
to check out the firstepisode in this series.
Wash your Hands, DiscerningFacts from the Preposterous
Versus Plausible, whichis NP Pulse episode 142,
and stay tuned for the finalinstallment coming this May.
As always, thank you for yourcommitment to excellence in
patient care.

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