Seven steps to overcoming your patient’s ‘fear of finding out’

Health psychologist Angel Chater explains the motivational interviewing techniques that can help nurses connect with patients who seem unmotivated or ambivalent about accessing healthcare

Health psychologist Angel Chater explains the motivational interviewing techniques that can help nurses connect with patients who seem unmotivated or ambivalent about accessing healthcare

Picture: Alamy

Have you ever come across a patient who seems disengaged with their health – in particular, reticent about seeking treatment or acting on clinical advice? If you have, you are not alone.

Most nurses will have met patients who appear to lack the motivation, time or commitment to make changes to their lifestyle to improve their well-being. For a health professional, attempting to help patients who seem ambivalent about helping themselves can be extremely frustrating.

The underlying cause of this seeming ambivalence may be fear – the fear of finding out they are ill or at risk of illness, or of the impact that lifestyle changes or treatment could have on their work, relationships and finances.

Delays in seeking advice

According to a report by think tank 2020health, in partnership with pharmaceutical company AbbVie Inc, the ‘fear of finding out’ makes up nearly a third of all conscious decisions to delay or avoid seeking advice about health concerns, or not take the appropriate steps to improve health. The report also found that men and single people are more likely than others to postpone seeking advice.

Fear is often hugely challenging to overcome, but there are techniques you can use to help patients engage with healthcare and ultimately take control of their well-being.

How to help your patient

The following tips, based on a motivational interviewing approach, can prove useful when trying to help patients who may have a 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 important in helping people to feel they can trust you and, importantly, that you are there to listen to them.

A good conversation starter to encourage patients to open up to you is: What is troubling you today? This open-ended question enables the patient to respond freely, 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. Although a natural part of your job as a nurse is to give your patient advice on the importance of getting their health checked, this instinct – which psychologists call the righting reflex – could in fact make the patient less open to seeking help.

Resisting 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 with a health concern to have a check-up, 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 It is only natural for people to push fear to the back of their minds as a coping mechanism to avoid addressing it. Someone who does have a fear of finding out when it comes to their health may instead present with avoidance issues or behaviours. For example, they may say: ‘I don’t have time to go to the doctor’.

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, their cat or their workplace. 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 health 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.

While 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 for vital information to give you the insight needed to help them.

5. Evoke In asking open questions, you will be encouraging the patient to cognitively understand their situation. They may have never been asked these questions before and are unlikely to have ever asked themselves these questions.

By asking them outright the patient may be more likely to admit the true reasons why they are not engaging with health services. This may be a turning point in the patient’s understanding that they have a fear of finding out.

They may tell you that they are afraid of discovering they are unwell, in case that means they are unable to take care of those who rely on them, or fulfil their duties at home, at work or in relationships. They may be concerned about the financial implications or worried about undergoing a medical procedure. Reflect back to them what they say to you.

6. Support Once your patient has opened up about their fear of finding out, it is important to understand what they need to tackle it. Ask questions that will help you to understand how knowledgeable they are about the health services available to them, the condition they may have, and what their support network is like – for example if they have access to transport or social support if needed.

Try to establish how self-confident they are and how motivated they will be to take further advice. With this insight, you will be able to support them accordingly. Keep these questions open-ended.

7. Plan Help your patient to plan a way forward. Try to help them understand what they need to do to engage with health services. It is 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.

Again, open-ended questions are useful in eliciting this information:What will you do from here? Who can help you?  How confident are you that you will do this? How can I support you?

Angel Chater is a reader in health psychology and behaviour change at the University of Bedfordshire. Dr Chater is collaborating with Live:Lab on ways to help people take control of their well-being

Further information



Fear of Finding Out: Identifying psychological barriers to diagnosis in the UK

Online game on the fear of finding out

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