One of the basic tenets of patient-centered care (a hot topic in audiologist circles these days) is collaborating with patients throughout the goal setting and treatment planning process. Unlike the traditional paternalistic service delivery model in which clinicians essentially tell patients what to do, patient-centered care necessitates patient-provider partnerships that are based on trust and mutual respect. In ENT-audiology clinics, there are two simple ways clinicians can create better, more fruitful partnerships with patients who are candidates for hearing aids.
1. Pair an emotion with a listening situation in the goal setting process
During the standard goal-setting process, a time when many audiologists use the COSI to target and record areas of improvement, pair the problematic listening situation nominated by the patient with the emotion felt by the patient that results from the inability to hear. For example, if frequent gatherings at a favorite restaurant is a listening situation to be targeted for improvement, ask the patient to share the emotions associated with an inability to hear in that place. The goals recorded on the COSI looks like this:
- Reduce frustration and annoyance at favorite restaurant with friends
- Improve enjoyment of TV watching with family
- Lessen embarrassment of missing conversations with cashiers at grocery store and other shops
- Improve satisfaction of participating in activities with grandkids
Notice the goals are either enhancing a positive emotion associated with an activity or lessening a negative emotion associated with an activity. There is one simple reason for pairing an emotion with a problematic listening situation: People are more likely to form a deeper, trusting relationship when they feel comfortable talking about feelings. That is, by focusing on an emotion with a place or activity, you are centering the goal setting process on the person, not on the device. When a clinician and patient explore the feelings associated with hearing loss, a stronger partnership that yields successful treatment outcomes is more likely to occur.
If the notion of talking about feelings is uncomfortable for you, use a standard questionnaire, like the HHIE-A, to facilitate the process. Use the five emotion-based questions on the HHIE-A to get the process started. For example, if the patient provides a “yes” response to the questions pertaining to embarrassment, annoyance or frustration associated with an inability to hear, logical follow-up questions are, “Tell me where you feel annoyed” and “How annoyed do you feel?” To learn more about using the HHIE-A, see https://consultgeri.org/try-this/general-assessment/issue-12.pdf.
2. Involve the communication partner
Another application of the HHIE-A is to gather information from both the patient and their communication partner. It is common, for example, that a communication partner indicates the patient has a significant handicapping condition, while the patient himself has no self-perception of a handicapping condition. This disconnect between patient and their communication partner in hearing loss as a handicapping condition is an opportunity to explore why these disconnections could lead to a comprehensive treatment plan.
One way to create effective partnerships with patients and their communication partners is allow both parties to draft treatment goals associated with hearing aid use. Jill Preminger of the University of Louisville and others associated with the Ida Institute have developed a goal sharing process that involves the patient and communication partner.
The five-step process is outlined in Figure 1. Step one involves both parties listing places where communication between them is relatively easy. This could be situations such as conversations at the dinner table or in a quiet room between the two of them. Step two involves each party listing communication problems each experience and then turning the tables, listing problems they believe the other person might be experiencing. Step three asks both parties to come to some agreement on problems both experience because of the patient’s hearing loss. Finally, step four enables both parties to put all that information together and create some shared goals.
With a few modifications to the patient consultation process, like the two mentioned above, audiologists and patients benefit from closer partnerships. Patients benefit by having a trusted professional that can depend on for help and guidance, while providers can enjoy the fruits of more loyal patients who appreciates their service.