Family-Centered Care | May 2018 Hearing Review
Editor’s Note: As reported in The Hearing Review online, Phonak has convened a select group of hearing healthcare experts to provide evidence-based recommendations to hearing care providers on how to better engage family members. The group proposes an audiologic treatment shift from a site-of-lesion focus to a family-centered care perspective as a means of increasing the value of our services and the uptake of hearing devices. This paper is the fourth in a series of several common (mis-)beliefs or myths challenged by the authors. Click here to access Mythbusters #1, Mythbusters #2, and Mythbusters #3.
How often have we looked into the faces of our clients and their families as we describe the audiogram in fine detail only to find anxious, blank, or confused faces staring back at us? Although the audiogram has an important place, the weight of this information may do less than we expect to convince clients of their need to take action. Given the increasing acknowledgement of the importance of adopting a family-centered care (FCC) approach to hearing healthcare for adults, the expert circle took a moment to consider where the audiogram sits in a FCC approach, and why it may not be as important to clients as it is to us.
1) The audiogram may not provide the most useful information for our clients to aid decision making. Clients’ decisions to seek our services are based more on their perceived needs than on their measured hearing loss (see Meyer and Hickson1 for a review). The perceived needs of clients and their families are couched more often in terms of the impact of hearing loss on everyday communication rather than on characteristics of hearing sensitivity itself.
Consider for a moment the regular eye tests you have with your optometrist. After completing a range of tests, the optometrist will rarely describe the specific results in detail or the meaning of the numbers on your glasses prescription. This doesn’t mean that the numbers don’t matter. They matter to an optometrist, but not so much to you. All you are concerned about is whether you need glasses or not.
2) We may provide too much information to our clients at assessment. At any given appointment, clients can only remember so much. Information needs to be presented gradually, using a variety of formats.2 Absorbing detailed information about the audiogram, and dealing with the diagnosis of a hearing loss, may be too much for clients to process all at once. Adults tend to use past experience in learning and want to know what is relevant to their own understanding of their needs.3 It is not necessarily the detail of the audiogram that motivates clients to adopt hearing devices, but rather their own lived experience of communication difficulties. Talking about the audiogram is more suited to our needs than it is to the client’s needs.
3) Family-centered care places our clients in the context of their everyday lives. Many clients and family members do want to understand how their test results are connected with their everyday communication challenges. While the audiogram discloses information about ears, FCC focuses more directly on the problems arising in our clients’ everyday lives—most commonly the communication difficulties as perceived by them and their family and friends. Information linked to personal communication challenges and needs are best shared, understood, and addressed so clients can be actively involved in decision making, all common elements in many FCC frameworks. These issues provide us with the best goals and measures of the success of intervention.
The next time you are with a client and their family member(s), ask them if they would like specific information about the audiogram. Engage them in a discussion of how the communication challenges they experience are linked to their personal audiogram.
Mary Beth Jennings, PhD, is Associate Professor in the School of Communication Sciences and Disorders and the National Centre for Audiology at the University of Western Ontario; Christopher Lind, PhD, is Senior Lecturer in Audiology in the Department of Speech Pathology and Audiology at Flinders University, Adelaide, Australia, and Nerina Scarinci, PhD, is Senior Lecturer in Speech Pathology and Audiology at The University of Queensland.
Meyer C, Hickson L. What factors influence help-seeking for hearing impairment and hearing aid adoption in older adults? Int J Audiol.2012;51(2):66-74.
Watermeyer J, Kanji A, Mlambo N. Recall and understanding of feedback by adult patients following diagnostic audiological evaluation. Int J Audiol.2015;54(10):758-763.
Knowles M. Andragogy: An Emerging Technology for Adult Learning. In: Knowles, MS. London,The Modern Practice of Adult Education: From Pedagogy to Andragogy. Revised Ed. New York, NY:Cambridge Book Co; 1988.
Correspondence can be addressed to Dr Jennings at: [email protected]
Citation for this article: Jennings MB, Lind C, Scarinci N. Mythbusters’ myth #4: I have to discuss the audiogram. Hearing Review. 2018;25(5):22.