Informed Decision-Making: When One Size Doesn’t Fit All

By Katie Oestreich

This article is a part of the March/April 2019, Volume 31, Number 2, Audiology Today issue.

Throughout the years, health-care service delivery models progressed from a provider-centered method of care toward a greater focus on the patient. In addition, increased prominence has been placed on the use of empirical evidence in the decision-making process to promote clinical accountability. But how can audiologists best provide patient-centered care when each patient is so unique?

Decision-Making: A Shared Approach

A paternalistic approach, in which the clinician makes decisions for the patient, has historically dominated the health-care scene. However, rehabilitative audiology decision-making has been described as “a vital stage in the rehabilitative process in that key decisions are made jointly between the professionals and the hearing impaired” (Stephens, 1996). In its most basic sense, patient-centered care refers to patient–clinician interactions and it emphasizes the importance of relationship building, as well as sharing of input and control in information exchange and decision-making (Boisvert et al, 2017).

A relationship that has patient-centered care, communication, and shared decision-making at its center leads to better adherence by the patient, greater overall satisfaction, and a stronger sense of trust between the patient and clinician (Figure 1). Communication between the clinician and patient can enhance adherence through several mechanisms. For example, communication contributes to patients’ understanding of their hearing loss, as well as their treatment options. A clinician’s skill at communicating during the appointment is a central factor in achieving patient adherence as it improves the transmission and retrieval of important information; facilitates patient involvement in decision-making; and allows an open discussion of benefits, risks, and barriers to adherence. In addition, it builds rapport and trust and offers patients verbal and nonverbal support and encouragement (Zolnierek and DiMatteo, 2009).

A patient’s journey from the initial hearing evaluation, to hearing aid selection and follow-up care, involves numerous occasions during which decisions must be made. Patients must determine the extent to which they are affected by their hearing loss and if amplification or other treatment options are right for them. They must also consider the amount of time, expense, and follow-up care to which they are willing to commit, as well as make decisions involving counseling, communication strategies, individualized auditory training, amplification, and aural rehabilitation. With all the options and various paths to take in a hearing health-care plan, patients are bound to feel overwhelmed. Therefore, it is important for the clinician to provide patient-centered care with an emphasis on empirical evidence to make joint, informed decisions, tailored specifically to each patient.