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Opinion: Overhaul patient questionnaires for Ebola

A second Texas healthcare worker has been diagnosed

A second Texas healthcare worker has been diagnosed with Ebola after treating Thomas Eric Duncan, the first person in the U.S. who was diagnosed with Ebola. Photo Credit: Getty Images / Joe Raedle

Although the Centers for Disease Control and Prevention can be commended for its efforts to contain Ebola in Dallas and elsewhere, the effort could be improved with changes to health and risk communication.

Checklists for evaluating possible Ebola patients would benefit from being changed to an "active choice" format. Like most checklists, the current form for Ebola directs caregivers to check a box when a condition is present (Does patient have fever . greater than 101.5 degrees?) and make no response when it is not. However, equating a negative judgment (no fever) with inaction (not checking a box) discounts the mental effort the judge uses to reach it.

A more optimal checklist would require people to make an active choice between two options rather than just opting for one. This two-option format balances the consideration people give to positive and negative assessments. In this case, having caregivers actively choose between "yes" and "no" for each possible Ebola symptom could enhance the calibration of their judgments.

The language used to describe the health care worker's role in diagnosis should change from passive to active. Items describing diagnosis in the CDC checklist focus on the patient's actions, not the caregiver: Does patient have fever? Has patient traveled to an Ebola-affected area in the 21 days before illness onset? In contrast, those about post-diagnosis procedures emphasize the caregiver's actions: Isolate patient in a single room, notify hospital infection control program, etc.

In practice, caregivers must be as active during diagnosis as in subsequent procedures. Language that describes diagnosis in "caregiver active" terms (Check patient for fever symptoms, inquire about patient's travel to Ebola-affected areas, etc.) reinforces the caregiver's role in this process as an investigator, not a passive observer.

Patients should also understand that multiple caregivers asking them the same questions is necessary. For example, an intake nurse might ask whether the patient has traveled outside the U.S. in the past 21 days, and the physician might ask the question again. Yes, this is redundant, but it isn't patronizing or accidental. Repetition is important for careful communication. Asking the same question multiple times gives patients time to confirm responses and serves a check-and-balance function between caregivers.

Crisis situations are times of uncertainty for everyone involved. Along with epidemiology, quarantine, diagnosis and treatment, effective communication is the heart of effective disease containment.

Matthew S. McGlone and Keri K. Stephens are affiliates of the Center for Health Communication in the Moody College of Communication at the University of Texas at Austin.


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