Audiology and Speech Pathology - Theses
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ItemPatient-practitioner interactions: older adults and their audiologists( 2014)Hearing impairment increases in prevalence with ageing. If left untreated, hearing impairment can be a barrier to successful ageing and can cause a variety of negative consequences. Recent investigations of factors associated with hearing aid uptake and use by older adults revealed a paucity of research examining the value and influence of patient-audiologist interactions. Within the health professions, there is a growing interest in patient-practitioner interactions and in particular the quality of professional exchanges termed “patient-centred”. Philosophical and clinical definitions of the term are reported throughout literature where decades of research illustrate relationships between patient-centred care and improved patient outcomes. Before such relationships can be examined in audiological rehabilitation for older adults, the term needed first be defined and the existence of patient-centred interactions explored. This research utilised a mixed-methods design to triangulate patient-centred care in audiological rehabilitation as defined by older adults with hearing impairment with observed patient/companion-audiologist communication in audiology consultations. A sequential exploratory design was used across two studies. Firstly, a qualitative descriptive study was conducted with a purposively sampled group of older adults who owned hearing aids. This study explored participants’ experiences with audiologists and their definition of patient-centred audiological rehabilitation. The findings of this study are represented visually in two models. The first model describes the people, behaviours and processes required to provide patient-centred audiological rehabilitation: a therapeutic relationship was seen as central to patient-centred audiology interactions; the audiologist and patient were seen as key players; and the way two processes occurred (information exchange and decision-making) was considered instrumental in whether audiological rehabilitation was patient-centred. The second model provided an operationalised description of how patient-centred care can be clinically implemented. In this model, there were four dimensions: 1) therapeutic relationship, 2) informed patients, 3) involved patients and 4) individualised care. Results from Study 1 provided a rationale and focus for the examination of patient-audiologist communication in initial consultations and thus informed the second study. In Study 2, 63 initial consultations between audiologists and older adults (and companions in 17 cases) were filmed and analysed using the Roter Interaction Analysis System (RIAS). This method was used to examine the presence and nature of patient-centred communication. Analyses were conducted in two phases: Study 2a focussed on the history-taking phase of initial consultations and Study 2b focussed on the counselling phase. Taken together, the results revealed a dearth of patient-centred communication in initial consultations. That is, little communication was invested in developing a therapeutic relationship; patients were primarily informed only about hearing aids and audiologists asked closed-ended, biomedical questions thus limiting information received about patients’ needs. Little patient and companion involvement was observed. Audiologists rarely sought input from those accompanying the client and, in the presence of a companion, asked fewer psychosocial and lifestyle questions and offered less psychosocial and lifestyle education than when a companion was not present. Limited individualisation of information and options was observed. At the conclusion of this thesis, the results of Study 2 were juxtaposed with the results of Study 1. The overall findings present an imperative to value and promote the quality of patient-audiologist interactions, beyond technical skills, in the provision of “patient-centred” audiological rehabilitation for older adults and in the education of students of audiology.