“Misinformation spreads quickly, and it’s hard to correct it in real time,” said Sing Palat, MD, CMD, at the start of the PALTC23 session “Managing Medical Misinformation: How to Address This Information Mess.” Leslie Eber, MD, CMD, agreed: “We are all vulnerable to misinformation, even those of us in this room. Information hunger makes us vulnerable. False information spreads faster and deeper than the truth. Repeat exposure is an effective strategy for spreading misinformation.” However, Drs. Palat and Eber and their colleagues offered some strategies and concepts practitioners can use to promote trust, collaboration, communication, and mutual respect. With the proliferation of misinformation and so many venues through which it spreads, said Dr. Eber, “there is a need to pivot from how we used to address misinformation and myths.” To stop misinformation, we must first understand how it spreads. Its strategies are fairly simple:1.To start, repeat the false information often. “The more a claim is repeated, the more familiar it becomes, and the easier it is to process,” said Dr. Eber.2.Add personal testimonials that “provoke a strong emotional reaction” — these are likely to be amplified via social media.3.Then mix in a kernel of truth with the false information to lend some credence to it and muddy the waters. Misinformation tends to be intentionally vague and involves fake experts. It also exaggerates partisan grievances and presents fringe views as mainstream. “Trust is essential to counter misinformation,” said Erin O’Brien (formerly Vigne), MA, RN, director of clinical affairs at AMDA - The Society for Post-Acute and Long-Term Care Medicine. “We first need to build and maintain trust with our teams as leaders, and teams need to trust each other.” She detailed the three drivers of trust, as identified by Frances X. Frei, PhD, and Anne Morriss, MBA: authenticity, empathy, and logic (Harv Bus Rev, May–June 2020, https://hbr.org/2020/05/begin-with-trust). “If one of these three components has a wobble, your trust is on shaky ground,” Ms. Vigne said. Building trust isn’t one and done, she stressed. “You don’t build trust and move on. You have to work to maintain it.” One way to build trust while countering misinformation is to use motivational interviewing. According to the American Psychological Association, this type of interviewing is “particularly applicable when low intrinsic motivation for change is an obstacle. Rather than advocating for and suggesting methods for change, this approach seeks to elicit the client’s own goals, values, and motivation for change and to negotiate appropriate methods for achieving it” (“Motivational Interviewing,” in APA Dictionary of Psychology, https://dictionary.apa.org/motivational-interviewing). Motivational interviewing, said Ms. O’Brien, is based on compassion. Using a person-centered conversation, you address someone’s ambivalence about change and thereby strengthen that person’s motivation to change. This process progresses by:•Engaging the person and building/supporting a relationship of mutual trust and respect.•Focusing on choosing and keeping a specific direction.•Bringing out each other’s strengths, knowledge, and ideas about the situation at hand.•Planning with that person to help him or her take a specific action. Ms. O’Brien offered, “Try not to start questions with ‘why.’ Instead, invite the person to talk to you about what is bothering them. ‘Why’ puts people on the defensive.” Motivational interviewing encourages people to explore ideas that they were initially resistant to, and it promotes mutual respect and concern. To this end, motivational interviewing has four guiding principles:1.Resist the “righting reflex” — don’t just tell people they are wrong and then what is right. This is a process: you want to help them see your view and come to new conclusions on their own.2.Understand and explore the person’s motivation. Try to find out why people feel the way they do.3.Listen. Really listen to what people are telling you. Ask them questions, and give them time to respond.4.Empower the person. Make people feel that they have a choice and are respected. Help them see that you are on their side and value their feelings. Motivational interviewing is conducted by:•Engaging — building and supporting a relationship where trust and respect go both ways.•Focusing — using an ongoing process of choosing and keeping a specific direction.•Evoking — bringing out one another’s strengths, knowledge, and ideas about the situation.•Planning — being with someone while they form a specific action to take. Consider this example offered in the presentation of a physician talking with a certified nurse assistant (CNA) about vaccination: Clinician: “What do you know about the side effects of the COVID-19 bivalent booster?” CNA: “I have a friend who was so tired after her booster shot that she missed work, so I know it can cause fatigue, and I can’t afford to miss work.” Clinician: “Yes, fatigue is a possible side effect of the vaccine. Are there other side effects that concern you?” CNA: “Well, I know I could have a sore arm or headache, but I am mostly concerned about feeling tired and missing work.” Clinician: “I certainly understand that. You are worried about being tired after your shot and maybe missing work. Is there a way you could schedule your shot for when you don’t have to work the next day?” Motivational interviewing can help us determine when someone is embracing or considering misinformation. “We can’t assume that we know why someone thinks or feels the way they do,” said Ms. O’Brien. There is a growing body of literature demonstrating the effectiveness of “pre-bunking” misinformation before it takes hold. For instance, some research shows that free online games that provide tools to fight misinformation can encourage healthy skepticism when people read the news. More common is the use of debunking. This, said Dr. Eber, is “key to un-ringing the bell.” There are four basic steps to debunking misinformation:1.Lead with facts. Keep these simple, and use expert sources.2.Warn about myths. Do this only once so as not to repeat them.3.Expose the techniques of manipulation. Explain how and why the myth is false.4.Conclude with the facts (again). Provide a credible alternative explanation. Dr. Eber also offered some tried-and-true tips for debunking: make information simple and easy to digest, listen to concerns, be empathetic, use personal stories and lived experiences, know your audience, and use community-credible messengers to deliver the correction. “Rather than debunking every myth, it will be helpful to enable people to identify misinformation and avoid it,” said Dr. Palat. “Inoculation is proactive, builds skills to defend against misinformation, and creates a defense against manipulation.” Inoculation against misinformation requires proactive messaging. In post-acute and long-term care, this may include using town halls, providing information with a specific disease focus, debunking internet stories using a checklist, and holding morning huddles to review orders. Leaders who are present as trusted resources and who take into account different needs, values, and cultures are key to inoculation. “Keeping the door open is one of the most powerful things you can do,” Dr. Palat said. “We need to find common ground and remember that we have the same goals.” Senior contributor Joanne Kaldy is a freelance writer in New Orleans, LA, and a communications consultant for the Society and other organizations.