There is a growing movement within audiology to become more patient-centered. Although the term “patient-centered” is a little fuzzy, it essentially means focusing more attention on the psychosocial aspects of hearing loss and the impact hearing loss has on daily activities, while spending less time talking about the patient’s test results and technology options. In a clinical approach that is truly patient centric, the hearing aid selection process, while still important, is a means to an end. That is, how the patient uses the hearing aids to improve their emotional and social well-being matters more than the audiogram and hearing aids themselves.
According to several research reports summarized by Meyer et al1, audiologists have difficulty practicing patient-centered care. In one study2, patients perceived their audiologist to be emotionally distant and constantly seeking to control the interaction. In another, less than five percent of the audiologist’s dialogue with the patient addressed an emotionally-related topic. And, when emotional topics were raised by the patient during the appointment, the audiologist failed to address them and instead focused on hearing aids and test results during the consultation.
If, as the research suggests, patients desire to talk about the social and emotional aspect of hearing loss, then it makes sense to have a way to seamlessly and effectively address emotional topics. After all, very few audiologists have any formal training in psychosocial counseling, yet individuals with hearing loss seeking help from a professional seem to crave dialogue that addresses the social and emotional consequences of living with hearing difficulties. Below is a simple six-step way to address the social and emotional needs of many patients, while maintaining a smooth workflow in your clinic.
As part of the routine needs assessment and case history portion of a hearing aid evaluation, ask patients to describe one to three emotions they feel about their hearing loss and the impact it might have on their ability to participate in routine activities. To make things easy for patients, ask them to choose from a list (or read from the list). If patients provide a lengthy list with many emotions, ask them to prioritize the list. “Which of these emotions do you feel during a routine day where communication is challenging?”
- None of these
- Other _______
If patients have a familiar communication partner with them at the appointment, ask the communication partner to generate their own list of emotions. It is always helpful to get the communication partner involved in the process. The communication partner’s list can be compared to the patient’s.
After the patient and communication partner have reached some agreement on a list of the most bothersome and/or challenging emotions associated with communication difficulty, spend a few extra minutes asking the patient and communication partner to elaborate on their feelings: “How often do you encounter those feelings?” or “Where are you most apt to feel that way?” are good follow-up questions that further the conversation and deepen the level of engagement. Additionally, ask patients to rate the strength of each emotion they’ve listed by having them record it on a 1 to 5 scale. A rating of 5 means incredibly strong, long-lasting feeling/emotion, while a rating of 1 would be a mild, fleeting feeling/emotion.
Record patients’ ratings for each emotion along with where and how often they encounter each emotion in a “Log of Emotional Consequences.” Make sure both you and the patient have a copy of the log that has been created at the appointment. This log serves as a baseline and might look like this:
Here are the feelings I have about my hearing loss and the places those feelings impact me:
- Frustration. Rated a 5 when I am with my wife in her favorite noisy restaurant.
- Tired. Rated a 5 at the end of a busy day at work when I have been in a lot of meetings.
- Anxious. Rated a 4 when I cannot understand what my boss and colleagues are saying during meetings and phone calls and I must continually ask them to repeat.
Following a month or so of hearing aid use (or another treatment option), revisit the patient’s “Log of Emotional Consequences.” Ask the patient to re-rate each of their scores for the areas of concern they generated prior to treatment.
Continue the dialogue. At each subsequent appointment update the “Log of Emotional Consequences” and record any new emotions or coping strategies the patient has developed.
At the end of the day, true patient-centered care involves more than helping patients master the use of their hearing aids. The tactics discussed above can be easily added to your Audiology EDGE process. By focusing attention on the emotional impact of hearing loss and creating a plan for how these negative emotions can be addressed in a proactive manner, you are guiding patients toward taking responsibility for their own outcomes and becoming more active and independent communicators. In an era when the sales of hearing aids are likely to be decoupled from the professional service component of care, this is one skill that cannot be replaced by artificial intelligence or a smartphone algorithm.
1. Meyer, C. et al (2016) What is the International Classification of Functioning, Disability and Health and Why is it Relevant to Audiology? Seminars in Hearing 37, 163-186.
2. Grenness, C. et al (2015) The Nature of Communication Throughout Diagnosis and Management Planning in Initial Audiologic Rehabilitation Consultations. JAAA. 26, 1, 36-50.