Category: Practice Building

This systematic approach to hearing aid counseling training allows for a better student learning experience and focuses on helping patients move forward with hearing healthcare. By Anne Eckert, AuD, MBA, CCC-A, and Virginia Gural-Toth, AuD, CCC-A To better assist students in mastering the art of hearing aid counseling as well as provide a framework for preceptors to guide students, a counseling tool titled “Define Your Listening Lifestyle, Partnering for Success,” developed by Audigy, was modified for use by the Hackensack Meridian Health JFK University Medical Center, Johnson Rehabilitation Institute’s Center for Audiology. The guide provides a process for counseling, emphasizing a comprehensive approach to hearing healthcare in a user-friendly manner. This tool promotes patient engagement by utilizing a 3-step process, including the interview, the hearing review, and a discussion of treatment solutions. Audiologists are skilled in following steps for completing the technical aspects of audiological procedures, from pure tone to vestibular, to other ear-related procedures. Practice guidelines assist in addressing the technical aspects of the delivery of care, making specific statements, recommendations, and strategies for the elements of care that optimize patient outcomes.1,2 But patient counseling is another aspect that is an integral component of the audiologist’s scope of practice. Helping patients and families understand, accept, and adjust to the impact of auditory, vestibular, or other ear-related disorders while focusing beyond the technical aspects of service delivery is just as essential. There is little debate regarding the importance of patient/family counseling in understanding hearing loss and selection of hearing aids. Research consistently shows counseling to be an essential factor in the acceptance of hearing loss, hearing instrument utilization, and satisfaction with hearing instruments. Berrett reported that people who have hearing loss and received effective counseling: • Wore the hearing instrument more often, • Wore the hearing instrument for longer periods, and • Reported a more significant perceived reduction in hearing handicap.3 Studies have also shown that failure to provide effective counseling can significantly contribute to patient dissatisfaction with hearing instruments. Given the relatively high level of user dissatisfaction with hearing instruments, it is critical to focus attention on the role of counseling in the practice of the hearing care professional.4 In a study by Pearson et al., supervisors reported that students usually focus on the “technical aspects of service delivery and tend to overuse technical jargon.” Students often have difficulty addressing patient issues that go beyond the information scope, neglecting to see the patient’s needs from a comprehensive perspective.5 Guiding Students for Effective Counseling Preceptors are tasked with assisting students in building vital counseling techniques. Often this is done through observation and mentoring. These methods are necessary and beneficial but lack a systematic approach that is transferable from patient to patient. How can preceptors assist students in building strong counseling skills? It was to meet this need in assisting preceptors and guiding students that the Johnson Rehabilitation Institute’s Center for Audiology adapted the “Define Your Listening Lifestyle, Partnering for Success” guide for counseling. Its purpose is twofold: (1) to guide students through a hearing aid consultation and (2) to better assist patients in moving forward with treating their hearing loss. The guide provides a step-by-step process for students to follow as they facilitate the conversation with patients to understand their hearing loss, the impact their hearing loss has on their day-to-day communication, and how untreated hearing loss has been linked to feelings of depression, anxiety, frustration, social isolation, and fatigue.6 Following the Steps The “Define Your Listening Lifestyle, Partnering for Success” guide for hearing aid counseling training follows an approach to the counseling process suggested by Sweetow, incorporating a professional and client-centered approach.7 It begins with an introduction of services provided and an outline of our mission statement: to “transform healthcare and serve as a leader of positive change.” Why would it be important to share this? We want our students to be able to convey with confidence to their patients why they should come to our practice for hearing healthcare and why we stand out as a leader. The patient’s test results are then reviewed with an explanation of the audiogram coupled with a visual. Sharing the audiogram allows the patient to understand their audiological results. The process includes the patient’s speech audiometry results, which are perhaps the most critical and relatable points of discussion, as they are key components in determining amplification options and predicting success. Following these steps leads to a conversation allowing the patient to identify those situations that pose personal listening challenges. Going through the process of describing and writing down each of these situations brings forward the primary motivators for amplification. A modified hearing healthcare questionnaire is built into the guide to assist in the process. Hearing aid questionnaires have been developed and researched extensively to benefit the hearing aid consultation process. While they are highly recommended, especially by professional organizations such as the American Speech-Language-Hearing Association (ASHA) and the American Academy of Audiology (AAA), many practices may not incorporate formal questionnaires into the appointment time. Patients are then encouraged to indicate the top three listening situations in which they would like to hear better. Having this information assists the student in determining the hearing aid technology level that best addresses the patient’s listening situations, helps define their listening lifestyle, and achieves their patient-centered goals. At this point, the student introduces a pricing structure. The students need to understand the importance of discussing all levels of technology rather than assuming what is best for a patient based on finances. In addition to emotional matters, pricing is equally challenging to teach as it may not be a comfortable subject for all patients. Defining Listening Lifestyle In concluding the consultation, students present patients with a comprehensive summary encompassing all the topics and information discussed throughout the appointment. On one page, the patient can easily access their hearing assessment score, the top three listening situations, the listening lifestyle, and the hearing loss range. The hearing aid recommendation and pricing information are provided in writing, and the protection plan is outlined. This includes a trial period, warranty information, and a follow-up care plan. The patients could ask additional questions, if any, and proceed with the hearing aid order. It is encouraged to have each patient leave with their personalized packet. Leaving the appointment with something tangible will only increase satisfaction levels. Benefits of Using the Guide There are several benefits to incorporating the hearing aid counseling training guide to aid preceptors in the process of teaching students how to conduct a thorough but effective hearing aid consultation. This organized and tailored consultation process assists the preceptor and the student in developing their own style while incorporating a structured and defined approach leading the patient toward success with amplification. We aim to standardize this teaching method for all students to ensure the highest quality of care, hoping that students will incorporate this method into their practice. Although initially this process may be perceived as time-consuming, following practice and streamlining communication, we have observed that the hearing aid counseling training guide can be completed in under an hour. It is our belief, through observation and return demonstration, that this systematic approach allows for a better learning experience and ultimately produces audiologists that are focused on helping patients move forward with hearing healthcare. In addition, the steps to better hearing are clearly outlined for patients so that they can make informed hearing healthcare decisions which result in greater success with amplification. This process supports a comprehensive approach to care, one that incorporates the commitment of the patient to hearing better, the expertise of the professional, and technology that suits the patient’s hearing and lifestyle goals. Anne Eckert, AuD, MBA, CCC/A, is the administrative director of rehabilitation at Hackensack Meridian Health, JFK University Medical Center, Johnson Rehabilitation Institute in Edison, NJ. Virginia Gural-Toth, AuD, CCC/A, is the manager of the audiology, tinnitus, and balance programs at Hackensack Meridian Health, JFK University Medical Center, Johnson Rehabilitation Institute. For more information, contact editor@hearingreview.com. Acknowledgments: The authors wish to thank Audigy, Business Solutions for Audiology, for helping build and customize concepts for this patient guide to ensure a straightforward patient journey process—also, the HMH JFK University Medical Center, Johnson Rehabilitation Institute audiology team. References 1. Valente, M, et al. Adult patients with severe-to-profound unilateral sensorineural hearing loss. American Academy of Audiology. Clinical practice guidelines. https://www.audiology.org/wp-content/uploads/legacy/PractGuidelineAdultsPatientsWithSNHL.pdf. June 2015. 2. American Speech-Language-Hearing Association. Preferred practice patterns for the profession of audiology. https://www.asha.org/siteassets/publications/pp2006-00274.pdf. December 21, 2006. 3. Berrett MV. Using patient counseling to increase wearer acceptance. Hear Instruments. 1993;44(3):9-12. 4. Kochkin S. MarkeTrak VI: 10-year customer satisfaction trends in the US hearing instrument market. The Hearing Review. 2002;9(10):14-25,46. 5. Pearson N, Muñoz K, Landon TJ, Corbin-Lewis K. Counseling skills in audiology. Hearing Journal. March 2019;72(3):50-51. 6. Kochkin S, Rogin CMA. Quantifying the obvious: The impact of hearing instruments on quality of life. The Hearing Review. 2000;7(1):8-34. 7. Sweetow, R.W. Counseling: it’s key to successful hearing aid fittings. Hearing Journal. 1998;52(3):10-17.

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