The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations

Grenness, Caitlin, Hickson, Louise, Laplante-Levesque, Ariane, Meyer, Carly and Davidson, Bronwyn (2015). The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations. In: World Congress of Audiology, Brisbane, Australia, (36-50). 3-7 May 2014. doi:10.3766/jaaa.26.1.5

Author Grenness, Caitlin
Hickson, Louise
Laplante-Levesque, Ariane
Meyer, Carly
Davidson, Bronwyn
Title of paper The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations
Conference name World Congress of Audiology
Conference location Brisbane, Australia
Conference dates 3-7 May 2014
Journal name Journal of the American Academy of Audiology   Check publisher's open access policy
Place of Publication Reston, VA, United States
Publisher American Academy of Audiology
Publication Year 2015
Sub-type Fully published paper
DOI 10.3766/jaaa.26.1.5
ISSN 1050-0545
Volume 26
Issue 1
Start page 36
End page 50
Total pages 15
Collection year 2016
Language eng
Formatted Abstract/Summary
Background: Effective practitioner-patient communication throughout diagnosis and management planning positively influences patient outcomes. A patient-centered approach whereby patient involvement in decision making is facilitated, a therapeutic relationship is developed, and information is bilaterally exchanged in an appropriate manner, leads to improved patient satisfaction, adherence to treatment, and self-management. Despite this knowledge, little is known about the nature of audiologist-patient communication throughout diagnosis and management planning.

Purpose: This research aimed to explore verbal communication between audiologists and patients/companions throughout diagnosis and management planning in initial audiology consultations. Specifically, this study aimed to describe the nature and dynamics of communication by examining the number, proportion, and type of verbal utterances by all speakers (audiologist, patient, and companion when present). In addition, this study aimed to investigate the influence of audiologist, patient, and consultation factors, such as verbal dominance, content balance, and communication control, on the dynamics of communication.

Study Sample: A total of 62 initial audiological rehabilitation consultations (involving 26 different audiologists) were filmed and analyzed using the Roter Interaction Analysis System. All patients were older than 55 yr, and a companion was present in 17 consultations.

Data Collection and Analysis: This study focused solely on the communication relating to diagnosis and management planning (referred to as the “counseling phase”). Diagnosis, recommendations, rehabilitation options, and patient decisions were recorded along with the communication profiles and communication dynamics measured using the Roter Interaction Analysis System. Associations between communication dynamics (content balance, communication control, and verbal dominance) and eight variables were evaluated with Linear Mixed Model methods.

Results: The mean length of time for diagnosis and management planning was 29.0 min (range, 2.2‐78.5 min). Communication profiles revealed that patient-centered communication was infrequently observed. First, opportunities to build a relationship were missed, such that patients’ psychosocial concerns were rarely addressed and patients/companions showed little involvement in management planning. Second, the amount of talk was asymmetrical and the majority of audiologists’ education and counseling utterances related to hearing aids; yet, only 56% of patients decided to obtain hearing aids at the conclusion of the consultation. Hearing aids were recommended in 83% of consultations where a hearing loss was diagnosed and alternative options were rarely provided. Thus, shared decision making rarely occurred, and audiologists often diagnosed a hearing loss and recommended hearing aids without patient involvement. In addition, when a greater proportion of time was dedicated to diagnosis and management planning, patients had greater input and control by asking more questions and requesting further information.

Conclusions: Patient-centered communication was rarely observed in the 62 consultations. Thus, although not measured in this study, patient outcomes are likely to be affected. Future research should examine the influence of audiologist communication on outcomes and encourage a shift toward patient-centered audiological rehabilitation.
Keyword Aging
Hearing aids
Interaction analysis
Patient-centered care
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

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