Building Trust and Improving Outcomes With Family-Centered Hearing Care What are strategies for better partnering with patients and their families in audiologic care? Jill Preminger shared some in a recent online chat. Overheard
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Overheard  |   January 01, 2018
Building Trust and Improving Outcomes With Family-Centered Hearing Care
Author Notes
  • Jill Preminger, PhD, CCC-A, is division chief of communicative disorders and program director for audiology at University of Louisville School of Medicine. She is an affiliate of ASHA Special Interest Group 7, Aural Rehabilitation and Its Instrumentation. jill.preminger@louisville.edu
    Jill Preminger, PhD, CCC-A, is division chief of communicative disorders and program director for audiology at University of Louisville School of Medicine. She is an affiliate of ASHA Special Interest Group 7, Aural Rehabilitation and Its Instrumentation. jill.preminger@louisville.edu×
Article Information
Hearing & Speech Perception / Hearing Aids, Cochlear Implants & Assistive Technology / Overheard
Overheard   |   January 01, 2018
Building Trust and Improving Outcomes With Family-Centered Hearing Care
The ASHA Leader, January 2018, Vol. 23, 28. doi:10.1044/leader.OV.23012018.28
The ASHA Leader, January 2018, Vol. 23, 28. doi:10.1044/leader.OV.23012018.28
Participant: If a participant were to put into practice only one idea from your session, what would that one key takeaway be?
Jill Preminger: I think that the most important takeaway is communication—to remember that our patients are our partners in hearing health care. They are the experts in understanding their experience and their communication. If we take the time to listen to their stories, that will build trust and a relationship.
Participant: Is there any research showing that offering a money-back guarantee instills more trust in the hearing aid purchasing process? If so, would a longer money-back guarantee period encourage more trust? Is there an industry standard, other than what is federally mandated?
Preminger: I don’t know that there are any federally mandated money-back guarantee requirements. It is my understanding that this is determined at the state level. In focus groups that I have held with individuals considering hearing aids, those who were unaware of trial periods were very pleased to learn about them. Based on that, I would think a trial period would increase trust. Also, related to cost, a recent article by Ekberg and colleagues in Australia has shown some interesting data. When audiologists made a single recommendation for a hearing aid and gave the price, the patient often shut down the discussion. However, when the audiologist discussed a range of options and associated prices, the patient was willing to discuss hearing aids. This suggests that the patient wants to be a part of the discussion and have some control over the outcomes. In other words, they want to participate in shared decision-making!
Participant: How are you preparing students to develop skills in trust-building?
Preminger: We have a counseling class during the summer of our first year and we discuss trust in that class. Students are typically so concerned about which button to push that they have a difficult time actually listening to their patients. We have never used an outcome measure to measure trust in the clinic. But I think that if a patient follows our treatment recommendations, then we have built trust!

If a patient uses a hearing aid successfully, then family members will benefit, too.

Participant: Is there research showing that if audiologists teach adaptation skills, such as using closed captions, does it foster trust by not focusing solely on the use of the hearing aid?
Preminger: I recommend using some type of structured discussion with a patient such as the COSI [see the Leader article from July 2016] or the GPS (Goal-sharing for Partners Strategy) for students to help how they communicate and build trust with patients. Unfortunately, there is very limited research about trust in audiology. However, there are data about patient satisfaction. I have recently done a series of focus groups with individuals with hearing loss who have not pursued hearing aids. Most were very concerned about the price (and the stigma). When we spoke with participants about comprehensive AR [audiologic rehabilitation]—for example, that there are hearing assistance technologies such as “TV ears” or closed captions—they became much more interested in discussing management options with their audiologist. Again, I think that if patients have the opportunity to select among a number of management options (TV ears, auditory training or hearing aids) they will be much more likely to seek out our services. They may start right away with the TV ears. But because they have built a relationship with you, it is likely that they will be back and may pursue a hearing aid next.
Participant: Why do you think that bringing a family member to the appointment leads to more hearing aid buying?
Preminger: There is no definitive research as to why bringing a family member into an appointment increases the uptake of hearing aids. However, I think that one of the likely reasons is due to the high cost of hearing aids. If you went out after work today and spent $5,000 on a new refrigerator without discussing it with your spouse, do you think he/she would be upset? Most of us feel it necessary to discuss expensive purchases with a family member. In this way, we can discuss the pros and cons of the investment. If a patient uses a hearing aid successfully, then family members will benefit, too. So, hopefully, most family members will be supportive of purchasing hearing aids.
Participant: Does bringing a family member to the appointments lead to more compliance once the hearing aids are purchased?
Preminger: Louise Hickson from Australia has some research on this. Her group has shown that people whose family members encouraged them to take up hearing aids were more likely to be successful hearing aid owners. In our work, we have found that adult children are typically very supportive of hearing aid use in their parents. Even if the adult children do not attend the appointment, many feel responsible to support their parents’ hearing aid use. One person explained that she called her mother every morning and asked her, “Have you taken your pills? Are your hearing aids in?” If we can get family members into the appointment they will see firsthand how a hearing aid improves their loved one’s speech communication. We can then give them tips on how to support their loved one’s hearing aid use. This should result in better outcomes for all.

If we can get family members into the appointment, they will see firsthand how a hearing aid improves their loved one’s speech communication.

Participant: What strategies can be employed when the spouse does not want to support the hearing aid user? I had a patient who had trust in me but the spouse refused to assist them with communication strategies. She was his primary communication partner.
Preminger: I have found that the best way to deal with an unsupportive spouse is for them to truly understand the communication problems that their spouse (with HL) experiences. The best way to make this happen is in a group setting. Some audiologists (mostly at VAs) do group hearing aid-fitting orientation appointments. This way, the spouses can see that it is not just their spouse with HL that has communication problems, but all people with HL. But if a group is not possible, I would suggest using the GPS. This will be a way to (hopefully) help the couple see that they each contribute to the communication difficulties. Thus, they are each responsible for solving the communication problems. Help the couple to understand that they are each responsible for communication.
One way to frame the discussion is to explain that “it is not ‘his’ hearing loss—it is the whole family’s hearing loss.” In other words, the hearing loss is not owned by the person with hearing loss, but it is a challenge for the whole family. One way to deal with this is to start the appointment with an explanation of what will be happening during the appointment: “I will be asking questions from each of you. I want to know how the hearing loss impacts each of you. I will ask each of you for your opinion because each of you experiences the hearing loss. In order to make sure that each of you has a chance to speak and to make sure we cover all of the important topics, please let me move the conversation along when necessary.”
Participant: Is work underway to understand how older adults prioritize or value how they contribute to trust or interact with one another? For example, if I needed a surgeon, I would rank technical skill and the facility higher than the surgeon’s “bedside” manner.
Preminger: Unfortunately, it is not easy for a patient to determine the technical skill of their surgeon, general practitioner or audiologist. That is why they often build their trust on their communication competence. One thing we are exploring right now is to come up with a “question prompt list” for patients to ask their audiologist—a list of questions to ask about management options and hearing aid options. If the audiologist can speak knowledgably about these topics (which all audiologists can do!) then this could be one way of measuring technical competence.
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January 2018
Volume 23, Issue 1