General foreword
This document presents Practice Guidance by the British Society of Audiology (BSA). This Practice Guidance represents, to the best knowledge of the BSA, the evidence-base and consensus on good practice, given the stated methodology and scope of the document at the time of publication. Although care has been taken in preparing this information, the BSA does not and cannot guarantee the interpretation and application of it. The BSA cannot be held responsible for any errors or omissions, and the BSA accepts no liability whatsoever for any loss or damage howsoever arising. This document supersedes any previous recommended procedure by the BSA and stands until superseded or withdrawn by the BSA.
This is a revised and updated version of BSA Practice guidance produced in 2016 that was titled Guiding Principles of Rehabilitation for Adults in Audiology Services.
This document will be reviewed by the date given on the front cover. The BSA are not liable for the maintenance of any of the sites mentioned in this document and that the links are provided solely as examples. However, should any individual or organisation feel that the content requires immediate update, review or revision, they should contact the BSA using the email bsa@thebsa.org.uk. Please add ‘BSA document revision request’ in the title. You will be asked to complete a short form with your reasons and this will be passed to the Professional Guidance Group for assessment.
Comments on this document are welcomed and should be sent to:
British Society of Audiology
Blackburn House,
Redhouse Road,
Seafield,
Bathgate,
EH47 7AQ.
Tel: +44 (0)118 9660622
bsa@thebsa.org.uk
www.thebsa.org.uk
Published by the British Society of Audiology
© British Society of Audiology, 2023
All rights reserved. This document may be freely reproduced for educational and not-for-profit purposes. No other reproduction is allowed without the written permission of the British Society of Audiology.
Authors & Acknowledgements
Produced by:
The BSA Adult Rehabilitation Interest Group Steering Committee
Key Authors:
Gabrielle Saunders
Manchester Centre for Audiology and Deafness, and NIHR Manchester Biomedical Research Centre, University of Manchester, UK
Laura Gaeta
California State University, Sacramento, California, USA
Helen Henshaw
NIHR Nottingham Biomedical Research Centre, and Hearing Sciences, School of Medicine, University of Nottingham, UK
Shahad Howe
Advanced Bionics, UK
Laura Turton
NHS Tayside, UK
- Declaration of competing interests by the authors: Shahad Howe is employed by Advanced Bionics UK Ltd who make cochlear implants.
With thanks to:
The BSA Professional Guidance Group, authors of the 2016 guidance (Melanie Ferguson, Lucy Handscomb, Helen Pryce), and Ann Marie Dickinson and all others who provided valuable feedback on earlier drafts of this document.
Citation
Please cite this document in the following format:
British Society of Audiology (2025), Guiding Principles of Person-Centred Care in Adult Hearing Rehabilitation. [Online]. Available from: . [Accessed date]
1. Abbreviations
ARIG: Adult Rehabilitation Interest Group
HASK: Hearing Aid Skills and Knowledge
NICE: National Institute for Health and Care Excellence
PROTEA: Patient Reported OuTcomEs in Audiology
SDM: Shared decision-making
2. Introduction
Hearing issues are typically chronic, they can be managed but rarely cured. Effective auditory rehabilitation is best achieved through a holistic approach that supplements sensory intervention with support to the person (the ‘patient’) and to their significant other(s)/communication partner(s).
The purpose of this document is to provide practical clinical recommendations to audiology and other healthcare professionals directly involved in the adult rehabilitation pathway based on the guiding principles used in adult rehabilitation. We recommend using a reflective approach to rehabilitation where the audiology professional plays the role of the ‘facilitator’, not the ‘fixer’. This document reflects best available evidence and is intended to support audiology professionals in identifying patient preferences for their care, especially for those who have long-term hearing conditions.
These guidelines outline current best practice in the audiological management of adults in hearing rehabilitation. Our approach has been to provide guidance regarding the way clinical interactions and processes are conducted rather than providing step by step guidance on specific practices because the evidence around these is evolving, while approaches to care are more established. We also acknowledge that due to time restrictions in some services, consultations may need to be prioritised to address the main needs of the individual and the guidelines should be considered with this in mind. Therefore, the recommendations should be interpreted as best practice and not mandatory.
Adaptations for special populations are important and necessary but are outside of the scope of these guidelines. For patients with intellectual disabilities, please refer to the BSA Intellectual Disabilities guideline. For Dementia Care adaptations, we recommend reading Hearing Assessment and Rehabilitation for People Living with Dementia (Dawes et al., 2021).
Following a short background in Section 2, we use Sections 3 and 4 to define the concepts used in our recommendations, and then in Section 5 provide specific recommendations for clinical practice. The ARIG PCC Toolkit (2024) provides information and links to useful support materials. A summary of our recommendations can be found in Appendix 1.
3. Background and Aims
Practical recommendations have been made around best clinical practice to support audiology professionals delivering adult rehabilitation. Each of these recommendations is linked to the tenets of person-centred care. In person-centred care: ‘professionals work collaboratively with people who use services. Person-centred care supports people to develop the knowledge, skills, and confidence they need to more effectively manage and make informed decisions about their own health and health care. It is coordinated and tailored to the needs of the individual and, crucially, it ensures that people are always treated with dignity, compassion, and respect’ (The Health Foundation, 2016, p3).
The principles of person-centred care were originally defined by Picker, an international charity that works across health and social care in the UK, Europe and the US to understand and further the link between patient experiences, person-centred care, and clinical excellence (Picker, 2024). The Picker principles were developed from interviews and focus groups with patients, their carers, and health professionals over a period of 20 years (Gerteis et al., 1993; Shaller, 2007), and the work continues today across Europe. The Picker charity and associated publications refers to ‘patient-centred’ care, which, throughout this document we refer to as ‘person-centred’ care.
In this document we take each Picker principle and use it to provide guidance across a typical audiological patient pathway.
To assist with understanding, we first provide a glossary of terms and concepts.
4. Concepts
4.1 Glossary
The following concepts used throughout this guidance:
Accessibility: Accessibility is about designing products, devices, services, environments etc., so that they are usable by people with disabilities. In 2017, the NHS released the Accessible Information Standard that specifies the approach that NHS care and/or publicly funded adult social care organisations are legally required to follow regarding identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss.
Continuity of care: The extent to which a person experiences an ongoing relationship with a clinician or clinical team to ensure co-ordinated clinical care that progresses smoothly as they move through their healthcare pathway.
Deaf awareness: Deaf awareness refers to being sensitive to the experiences, communication needs, and cultural identity of deaf and hard of hearing people.
Family-centred care: An approach to healthcare that recognises the vital role that families play in audiological treatment and rehabilitation. The engagement of family members (or communication partners) in the hearing consultation enables them to become valuable allies in the rehabilitation process. It accepts and considers the family to be the client, rather than just the person with the health condition (Epley et al., 2010; The Ida Institute).
Joint goal setting: Joint goal setting is the process by which individuals, significant others and relevant clinical professionals work together to discuss what they hope auditory rehabilitation will achieve in terms of hearing-related outcomes (McKenna, 1987; Hickson et al., 2016)
Joined-up working: Working collaboratively with other professionals and multidisciplinary teams and services.
Person-centred or patient-centred care: A person- or patient-centred approach means working collaboratively with the individual and their significant other(s) focusing on the elements of care, support and treatment that matter most to them, recognising they are an expert in their own hearing and treating them with dignity, compassion, and respect (The Health Foundation, 2016; The Ida Institute, 2023).
Rapport building: Rapport is defined as the ability to establish and sustain a working partnership and is considered critical to developing trust (Godsell et al., 2013; Workman et al., 2013). Relationships characterised by trust contribute to better care experiences, alleviate anxiety, and distress, and enhance patients’ involvement in decisions about their care.
Shared decision-making: Shared decision-making (SDM) is an approach where clinicians and individuals share the best available evidence when faced with the task of making decisions, and where individuals are supported to consider options, to achieve informed preferences. This has become an important feature of contemporary healthcare and offers an intermediate alternative between the individual having full decision-making control and having no say at all.
Self-efficacy: Self-efficacy is an individual’s belief in his or her capacity to execute behaviours necessary to produce specific performance attainments (Bandura, 1997). It reflects confidence in the ability to exert control over one’s own motivation, behaviour, and social environment. It can underpin the ability to self-manage hearing loss, where the audiology professional builds the individual’s confidence in their ability to achieve their goal(s). The audiology professional has a role to play in providing knowledge and support so that individuals can eventually live well with their hearing loss.
Self-management: There are many definitions of self-management but generally they encompass the concept that it involves the individual taking responsibility for their own behaviour and well-being. For long-term conditions, this refers to management of symptoms, interventions or treatment, and physical and psychosocial consequences alongside life-style changes (Barlow et al,. 2002).
Teach-back technique: The teach-back technique is a simple way to check your individual’s understanding by asking them to ‘teach back’ in their own words, the information and instructions you provided. You can expand it to have individuals ‘show you’ what you taught them about handling hearing aids (https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html). Teach-back has been shown to increase self-efficacy, self-management, and knowledge recall (Ha Dinh et al., 2016).
4.2 Picker principles of person-centred care
Picker principles of person-centred care (Shaller, 2007):
A. Access to care and reliable advice
B. Effective treatment by trusted professionals
C. Continuity of care and smooth transitions
D. Involvement and support for family and carers
E. Involvement in decisions and respect for preferences
F. Clear information communication and support for self-care
G. Emotional support, empathy, and respect
H. Attention to physical and environmental needs.
5. Recommendations for Practice
Below we provide recommendations for clinical practice based on the Picker principles of person-centred care. We provide recommendations as they apply to each of the Picker principles (A to H).
A. Access to care and reliable advice
Accessibility is fundamental to care provision. For care to be successful it is essential that the individual can communicate with and understand the audiology professional and the information they provide (ARIG PCC Toolkit, 2024). To achieve accessibility all staff should undergo deaf awareness training (Parmar et al., 2022; Morisod et al., 2022; Ubido et al., 2002; ARIG PCC Toolkit, 2024).
As per the Accessible Information Standard (2017) the overarching guidelines to enhance accessibility should include the following:
A1. Identify individual access needs (e.g., British Sign Language interpreter, a language translator, or use of live speech to text applications) and preferences (e.g., remote vs in-person) prior to the initial appointment and schedule accordingly for all future appointments and see (ARIG PCC Toolkit, 2024)
A2. Record the identified needs by documenting them in the individual record, and ensure they are used at every contact.
A3. Flag the identified needs by adding an alert in the individual database describing access needs to ensure there is continuity of use.
A4. Use visual or tactile communication tools in the waiting room (e.g., visual alerting system, white board, vibrating pager) to alert the person when calling them to their appointment .
A5. Make sure to use the information about access needs at all appointments.
Note: Although not directly associated with auditory rehabilitation, if the individual gives consent, share the individual’s access needs with their other providers so the correct support is received throughout their care.
B. Effective treatment by trusted professionals
Trust between individuals and their care providers leads to better health outcomes, greater satisfaction with care (Birkhäuer et al., 2017), greater adherence to the treatment and self-efficacy to adhere to the treatment, and higher expectations about outcomes (Fuertes et al., 2017; Olaisen et al., 2020). This is why it is critical to find ways to build trust with individuals. Some overarching approaches to building trust include:
B1. Be upfront in your communication and do not palliate messages to generate trust between you and your individuals.
B2. Be empathetic and show respect through active listening. Active listening entails listening attentively to what a individual is saying to understand the real meaning of what is being said, responding to the feelings shared, and noting non-verbal cues as well as verbal content (Rogers & Farson, 1987). Active listening requires empathy and openness to discussing emotional issues around hearing loss and providing emotional support when it is needed (ARIG PCC Toolkit, 2024).
B3. Use valid standardised tools to collect both self-report and behavioural (e.g. speech in noise performance) outcomes data to assess the effectiveness of the care you have provided (ARIG PCC Toolkit, 2024).
B4. Discuss outcomes and how they relate to meeting the individual / communication partner goals.
C. Continuity of care and smooth transitions
Joined-up working across health and social care is important for the individual (DHSS, 2022; Jeffers & Baker, 2016) therefore provide continuity of care. To facilitate this:
C1. Make detailed notes about the individual’s needs and preferences for the next audiologist to use, this might include noting the individual’s feelings, worries, concerns, beliefs, wishes and consent for treatment options.
C2. Read the individual’s notes from prior visit and check-in with the individual at the start of the appointment on any outstanding issues identified at the previous appointment so the individual has confidence that their needs have been heard and understood.
C3. Good record keeping is essential to keep other audiology colleagues informed of progress, and ensure the individual feels understood by the Audiologist and the wider service (Health and Care Professions Council, 2024).
C4. Ensure there is effective communication between any multi-disciplinary services, external agencies, and the referrer, and ensure the individual is kept informed throughout, this may involve email updates, phone calls or letters (Accessible Information Standard, 2017).
D. Involvement and support for family and carers
Where individuals’ consent, the involvement and engagement of family, carers and other communication partners in the rehabilitation process should be supported to ensure good adherence to clinical recommendations and improved outcomes (Kokorelias et al., 2019; Clay and Parish 2016; Ekberg et al., 2022) (ARIG PCC Toolkit, 2024). To achieve this:
D1. Encourage the individual to bring a communication partner to all appointments. Explain why this is recommended and take time to discuss which family member/friend might provide the best support. If the individual is resistant to this then let the matter lie.
D2. When present, actively involve the communication partner throughout all appointments – they are there to participate and share their views and experiences (ARIG PCC Toolkit, 2024). Engagement during needs assessment and goal setting is critical because these might differ between the partners (Manchaiah et al., 2012; Barker et al., 2017). If so, encourage discussion in the safe environment of the clinic so joint goals can be agreed.
D3. Observe the interactions between the individual and the communication partner with a view to providing supportive advice. Saunders et al. (2017) provide suggestions such as using individual and communication partner scores on companion questionnaires like the International Outcome Inventory for hearing aids (IOI-HA; Cox and Alexander, 2002) and the significant other companion version (IOI-HA SO; Noble, 2002) as the basis for a discussion of where opinions diverge and converge.
D4. Explain to the communication partner that they too have a role in the rehabilitation process that entails their use of effective communication strategies.
D5. Check that the management pathway and outcomes are meeting the needs of the communication partner as well as the individual.
Note: For adults with specialist communication needs (e.g., learning disabilities, Dementia, Autism), involve a multidisciplinary team to devise a communication plan, this may involve specialist Speech and language therapists (total communication) or third sector organizations (Empowered Conversations, 2024)
E. Involvement in decisions and respect for preferences
While the individual is not an expert in audiology, they know their own goals and preferences, even if it takes time and conversation to find out what these are. Individuals should thus be involved in decisions about management and intervention selection.
Note: Some individuals will vocalise that you, not they, should be guiding the decision-making process. This is a choice they have the right to make and one that should be respected.
Joint goal setting and shared decision-making entails working with the individual to involve them in decisions. This shows respect for individual preferences. NICE guideline 197 section 1.2 (2021) provides details for putting shared decision-making into clinical practice.
Joint goal setting requires a thorough understanding of the individual’s needs and goals which can be obtained through a needs/goals assessment (see below), while shared decision-making requires that the audiologist and individual work together to come to a joint decision regarding management options. To these ends, the following is recommended:
E1. Use either the recommendations in NICE Guideline 197 section 1.2 or the SHARE approach to conversation (Agency for Healthcare Research and Quality, 2014) throughout the individual’s care (NICE guideline 197, 2021; ARIG PCC Toolkit, 2024) This approach will help to facilitate conversation and provide advice whilst also considering the individual’s perspective. An understanding of the individual’s needs and expectations will allow you to tailor your care accordingly, e.g., if the individual is concerned about the cause of their hearing loss then spend time discussing this, if they have concerns about the loss progressing, then focus on that, and if they struggle at work then spend time focusing the rehabilitation on this.
E2. Consider using a decision aid to engage the individual in the decision-making process. Decision aids should provide information about all suitable and available treatment options (including the option to do nothing), list the pros and cons of each, the potential outcomes with each, and whether each has the potential to allow the patient to meet their goals. When using a decision aid, it is important to give the patient time to read and consider its contents at home with a partner, and then to discuss it with you at an appointment (NICE guideline 197, 2021; ARIG PCC Toolkit, 2024).
E3. Ensure the individual knows that (a) they can and should be an active participant in decisions about their care, (b) the management pathway is flexible and can be changed in the future and (c) that their communication partner should participate in decision making (ARIG PCC Toolkit, 2024).
E4. At each appointment ask the individual how the hearing technology is and is not meeting their needs/goals and whether they want to consider new goals and/or try alternative treatments. Celebrate positive outcomes, offer specific advice on how to deal with what is not working well.
E5. During assessment use audiometric test measures and explain the findings within the context of the individual’s needs/goals and their social and medical histories. i.e., make things relevant to the individual’s life (ARIG PCC Toolkit, 2024).
E6. Once hearing aid output has been verified using real ear measurements, be willing to adjust the output based on the individual’s sound preferences. However, be aware that self-report of hearing-aid sound quality is imprecise and can be inconsistent (Caswell-Midwinter and Wittmer, 2019). Consider features such as a volume control, additional programmes, mobile apps and / or hearing aid streaming to empower self-management in different listening situations.
E7. Document all decisions and actions in an Individual Management Plan that you complete in collaboration with the individual. Update the management plan with the above information and offer the individual/communication partner a copy in an accessible format.
Use management approaches and interventions that meet the individual’s needs (ARIG PCC Toolkit, 2024).
Ensure you know the local set up for accessing assistive technology so it can be provided if this is the individual’s preferred management approach.
See Table 1 for content to consider during goal setting.
| Category of needs | Considerations |
| Occupational | The individual’s working arrangements The acoustics of the individual’s workplace e.g., open plan situation, outside, classroom |
| Phone use | Frequency of use Difficulties encountered Video versus audio only |
| Social | Regular communication partners Difficulties encountered Activities (e.g., clubs, group meetings, large or small groups, other) Hobbies Role of listening Acoustic environments encountered Availability of assistive technology |
| General | Frequency of communication with unfamiliar talkers Impact of accents |
Table 1. Content to consider when goal setting.
F. Clear information communication and support for self-care
F1. Provide information in manageable chunks and check for understanding using teach-back. This process is sometimes referred to as ‘Chunk and Check’ (ARIG PCC Toolkit, 2024). Teach-back allows you to check individual understanding of information provided. Re-teach and retest if problems are encountered. This process will increase the individual’s self-efficacy for hearing aid use and management.
F2. All printed materials should be co-developed with the end-user (e.g., individual, communication partner). All materials must be easy to see, read and understand (ARIG PCC Toolkit, 2024).
F3. Many individuals struggle to understand graphs so rather than using the standard audiogram to explain the results of the hearing test, consider alternative approaches that are more focused on conversation. One such example is the Ida My Hearing Explained Tool (The Ida Institute, 2024). Another suggestion is to use online videos such as the C2Hear interactive multimedia videos (C2Hear, 2015) to help with hearing aid management.
F4. Use a structured assessment tool such as the Hearing Aid Skills and Knowledge (HASK, Saunders et al., 2018) or the Hearing Aid Skills and Knowledge Inventory (Bennett et al., 2018) to assess where the individual requires additional instruction and support with hearing device management.
F5. Signpost individuals to sources of extra help and information regarding, for example, lip-reading classes, hearing accessories, charities, and government support schemes, volunteer clinics, peer support, hearing aid repair appointments, written materials etc.
F6. Encourage independence, self-management and ownership of the Individual Management Plan but provide support as needed.
F7. Provide advice on communication tactics, how to deal with specific situations where hearing is challenging, how to access support at work (e.g., Access to Work, Deaf Awareness training for colleagues), and disclosing their hearing loss to others.
G. Emotional support, empathy, and respect
Systematic reviews show hearing loss is associated with increased odds of depression (Lawrence et al., 2020), loneliness (Shukla et al., 2020) and anxiety (Shoham et al., 2019) which may or may not require intervention from a mental health specialist. With this in mind:
If you think the individual needs help beyond that of an audiologist’s scope of practice, then refer them to the appropriate service and/or their GP. As noted by Greer-Clark et al. (2021) it is important for all providers, including audiologists to ‘watch attentively for concerns and situations, both stated and unstated, that may necessitate further activity for mental health exploration and the need for professional outside referral. When these are recognise, we must be comfortable addressing them directly and confidently to ensure that appropriate assistance is forthcoming.’
Under all other circumstances and if the individual is willing to do so:
G1. Ask the individual about their motivation(s) for coming to the appointment and what they want to achieve from their hearing care. If their motivation seems unclear, consider using tools such as the Ida motivation tools to further explore the matter (ARIG PCC Toolkit, 2024).
G2. Ask about other conditions that could affect intervention outcome, such as vision, memory, and manual dexterity. Being aware of the individual’s holistic needs will give a better understanding of their lifestyle and priorities. Individuals with multiple chronic medical conditions often place their hearing care at a low priority. Help the individual navigate this.
G4. Discuss how hearing loss is impacting the individual’s life in terms of mental health (do they feel lonely, socially isolated, vulnerable, or depressed?), and cognition (is listening fatiguing and/or effortful?) and the impact of these (do they lack confidence? how do they cope? do they need additional support?)
G5. Get to know your individuals by exploring what they enjoy doing, ask about their hobbies, who they regularly visit.
G6. Check in at follow-up visits to see whether any or all the above have changed following intervention.
H. Attention to physical and environmental needs
Physical needs should not take a backseat in audiology. Check in regularly whether:
H1. The individual is comfortable with the door of the soundproof booth closed.
H2. The transducers are comfortable.
H3. The individual needs a break at any time.
H4. The hearing aids are comfortable. Point out that the dome can be changed, or the ear mould remade.
If your individual is unable to self-report, point out to care staff and family the signs to look for that indicate the hearing aids may not be comfortable (e.g. redness at the opening to the ear canal, flinching when the hearing aid is inserted, pushing or pulling on the hearing aids).
6. Summary
Effective auditory rehabilitation is best achieved through a holistic approach that supplements sensory intervention with support to the person (the ‘individual’) and to their significant other(s). In this document we have provided recommendations that can enhance the success of auditory rehabilitation through application of the principles of person- and family-centred care. We emphasise the need for the audiologist to not only provide care in a compassionate and respectful manner, but also to work collaboratively with the individual and their family to help them develop the knowledge, skills, and confidence to manage and make informed decisions about their own health and health care more effectively. The eight Picker principles of person-centred care are used to structure our guidance for clinical care across a typical audiological individual pathway. Our approach has been to provide guidance regarding the way clinical interactions and processes are conducted rather than providing step by step guidance on specific audiological practices because these are changing constantly, while approaches to care do not.
7. References
Agency for Healthcare Research and Quality (2014). The SHARE Approach. Available at: https://www.ahrq.gov/health-literacy/professional-training/shared-decision/index.html Accessed 29 Mar 2023
ARIG PCC Toolkit (2024). Available at: https://www.thebsa.org.uk/special-interest-groups/adult-rehabilitation-interest-group/
Bandura, A. (1997). Self-efficacy: The exercise of control. W H Freeman/Times Books/ Henry Holt & Co.
Barker AB, Leighton P, Ferguson MA. Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners. Int J Audiol. 2017 May;56(5):297-305. doi: 10.1080/14992027.2017.1286695. Epub 2017 Feb 24. PMID: 28599604.
Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002 Oct-Nov;48(2):177-87. doi: 10.1016/s0738-3991(02)00032-0. PMID: 12401421.
Bennett RJ, Meyer CJ, Eikelboom RH, Atlas MD. Evaluating Hearing Aid Management: Development of the Hearing Aid Skills and Knowledge Inventory (HASKI). Am J Audiol. 2018 Sep 12;27(3):333-348. doi: 10.1044/2018_AJA-18-0050. PMID: 30208414.
Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, Gerger H. Trust in the health care professional and health outcome: A meta-analysis. PLoS One. 2017 Feb 7;12(2):e0170988. doi: 10.1371/journal.pone.0170988. PMID: 28170443; PMCID: PMC5295692
C2Hear (2015) Hearing well, together. Available at https://www.c2hearonline.com/ Accessed 19 Aug 2024.
Caswell-Midwinter B, Whitmer WM. The perceptual limitations of troubleshooting hearing-aids based on patients’ descriptions. Int J Audiol. 2021 Jun;60(6):427-437. doi: 10.1080/14992027.2020.1839679. Epub 2020 Nov 11. PMID: 33176515.
Clay AM, Parsh B. Patient- and Family-Centered Care: It’s Not Just for Pediatrics Anymore. AMA J Ethics. 2016 Jan 1;18(1):40-4. doi: 10.1001/journalofethics.2016.18.1.medu3-1601. PMID: 26854635.
Cox RM, Alexander GC. The International Outcome Inventory for Hearing Aids (IOI-HA): psychometric properties of the English version. Int J Audiol. 2002 Jan;41(1):30-5. doi: 10.3109/14992020209101309. PMID: 12467367.
Dawes P, Littlejohn J, Bott A, Brennan S, Burrow S, Hopper T, Scanlan E. Hearing Assessment and Rehabilitation for People Living with Dementia. Ear Hear. 2022 Jul-Aug; 43(4): 1089-1102 doi: 10.1097/AUD.0000000000001174.
DHSS (2022). Policy paper: Health and social care integration: joining up care for people, places and populations. Updated 11 Feb 2022. Available at: https://www.gov.uk/government/publications/health-and-social-care-integration-joining-up-care-for-people-places-and-populations/health-and-social-care-integration-joining-up-care-for-people-places-and-populations Accessed 29 Mar 2023
Ekberg K, Timmer BH, Francis A, Hickson L. Improving the implementation of family-centred care in adult audiology appointments: a feasibility intervention study. Int J Audiol. 2022 Jul 8:1-13. doi: 10.1080/14992027.2022.2095536. Epub ahead of print. PMID: 35801354.
Empowered Conversations (2024). A practical approach to staying connected to a person with dementia. Available at https://empowered-conversations.co.uk/ Accessed 19 Aug 2024.
Epley P, Summers JA, Turnbull A. (2010). Characteristics and Trends in Family-Centered Conceptualizations. J Fam Soc Work 13:269-285
Fuertes JN, Toporovsky A, Reyes M, Osborne JB. The physician-patient working alliance: Theory, research, and future possibilities. Patient Educ Couns. 2017 Apr;100(4):610-615. doi: 10.1016/j.pec.2016.10.018. Epub 2016 Oct 19. PMID: 27773600.
Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. San Francisco, Calif: Jossey-Bass; 1993
Godsell MR, Shaban RZ, Gamble J. “Recognizing rapport”: health professionals’ lived experience of caring for patients under transmission-based precautions in an Australian health care setting. Am J Infect Control. 2013 Nov;41(11):971-5. doi: 10.1016/j.ajic.2013.05.022. Epub 2013 Sep 12. PMID: 24035657.
Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database System Rev Implement Rep. 2016 Jan;14(1):210-47. doi: 10.11124/jbisrir-2016-2296. PMID: 26878928.
Health and Care Professions Council (2024). Standards: Record Keeping. Available at https://www.hcpc-uk.org/standards/meeting-our-standards/record-keeping/ Accessed 19 Aug 2024
Hickson L, LInd C, Preminger J, Brose B, Hauff R, Montano J. Family-centered Audiology Care: Making Decisions and Setting Goals Together. Hearing Review. 2016;23(11):14.
Ida Institute (2015). Family Centered Care. Available at: https://idainstitute.com/what_we_do/features/2015/sep_2015_family_centered_care/ Accessed 29 Mar 2023
Ida Institute (2024). My Hearing Explained Tool. Available at https://idainstitute.com/tools/my_hearing_explained/ Accessed 19 Aug 2024
Ida Institute (2023). What is Person-Centered Care? Available at: https://idainstitute.com/what_we_do/pcc_definitions/ Accessed 29 Mar 2023
Jeffers H, Baker M. Continuity of care: still important in modern-day general practice. Br J Gen Pract. 2016 Aug;66(649):396-7. doi: 10.3399/bjgp16X686185. PMID: 27481958; PMCID: PMC4979920.
Kokorelias KM, Gignac MAM, Naglie G, Cameron JI. Towards a universal model of family centered care: a scoping review. BMC Health Serv Res. 2019 Aug 13;19(1):564. doi: 10.1186/s12913-019-4394-5. PMID: 31409347; PMCID: PMC6693264.
Lawrence BJ, Jayakody DMP, Bennett RJ, Eikelboom RH, Gasson N, Friedland PL. Hearing Loss and Depression in Older Adults: A Systematic Review and Meta-analysis. Gerontologist. 2020 Apr 2;60(3):e137-e154. doi: 10.1093/geront/gnz009. PMID: 30835787.
Manchaiah, V. K. C., Stephens, D., Zhao, F., & Kramer, S. E. (2012). The role of communication partners in the audiological enablement/rehabilitation of a person with hearing impairment: An overview. Audiological Medicine, 10(1), 21-30. https://doi.org/10.3109/1651386X.2012.655914
Marsay S. (2017). DCB1605 Accessible Information Standard version 1.1. Available at https://www.england.nhs.uk/wp-content/uploads/2017/08/accessilbe-info-specification-v1-1.pdf Accessed 29 Mar 2023
McKenna L. Goal planning in audiological rehabilitation. Br J Audiol. 1987 Feb;21(1):5-11. doi: 10.3109/03005368709077768. PMID: 3828585.
Morisod K, Malebranche M, Marti J, Spycher J, Grazioli VS, Bodenmann P. Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review. Eur J Public Health. 2022 Aug 1;32(4):548-556. doi: 10.1093/eurpub/ckac056. PMID: 35640159; PMCID: PMC9341675.
Noble W. Noble W. Extending the IOI to significant others and to non-hearing-aid-based interventions. Int J Audiol. 2002 Jan;41(1):27-9. doi: 10.3109/14992020209101308. PMID: 12467366.
Parmer et al. 2022. Deaf Awareness, Accessibility and Communication in the NHS: How can we do better? BAA conference poster
Picker (2024). Who We Are. Available at: https://picker.org/who-we-are/ Accessed 19 Aug 2024.
National Institute for Health and Care Excellence (2021). NICE guideline [NG197] Shared Decision Making Published 17 June 2021. Available at: https://www.nice.org.uk/guidance/ng197/chapter/Recommendations#putting-shared-decision-making-into-practice Accessed 29 Mar 2023
Olaisen RH, Schluchter MD, Flocke SA, Smyth KA, Koroukian SM, Stange KC. Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health. Ann Fam Med. 2020 Sep;18(5):422-429. doi: 10.1370/afm.2554. PMID: 32928758; PMCID: PMC7489969.
Pryce H, Hall A J (2014). The role of shared decision-making in audiologic rehabilitation. SIG 7 Perspectives on Aural Rehabilitation and Its Instrumentation, 21 (1), 15–23. DOI: 10.1044/arri21.1.15
Rogers C, Farson R. Active Listening . University of Chicago Press, 1957.
Saunders GH, Morse-Fortier C, McDermott DJ, Vachhani JJ, Grush LD, Griest S, Lewis MS. Description, Normative Data, and Utility of the Hearing Aid Skills and Knowledge Test. J Am Acad Audiol. 2018 Mar;29(3):233-242. doi: 10.3766/jaaa.16153. PMID: 29488873.
Saunders GH, Preminger J., Scarinci N. Family-centered Care: Working with Partners Reporting “Incongruent” Hearing Aid Outcome. What to do when the patient’s and family member’s perceptions of the hearing loss differ. . Hearing Review. 2017;24(2):26-30.
Shaller D. (2007) Patient centred care – What does it take? The commonwealth Fund. Accessed 19.1.23. Available at: www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2007_oct_patient_centered_care__what_does_it_take_shaller_patient_centeredcarewhatdoesittake_1067_pdf.pdf
Shoham N, Lewis G, Favarato G, Cooper C. Prevalence of anxiety disorders and symptoms in people with hearing impairment: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2019 Jun;54(6):649-660. doi: 10.1007/s00127-018-1638-3. Epub 2018 Dec 13. PMID: 30547211.
Shukla A, Harper M, Pedersen E, Goman A, Suen JJ, Price C, Applebaum J, Hoyer M, Lin FR, Reed NS. Hearing Loss, Loneliness, and Social Isolation: A Systematic Review. Otolaryngol Head Neck Surg. 2020 May;162(5):622-633. doi: 10.1177/0194599820910377. Epub 2020 Mar 10. PMID: 32151193; PMCID: PMC8292986.
The Health Foundation (2016). Person Centered Care Made Simple. Available at: https://www.health.org.uk/sites/default/files/PersonCentredCareMadeSimple.pdf Accessed 29 Mar 2023
Ubido J, Huntington J, Warburton D. Inequalities in access to healthcare faced by women who are deaf. Health Soc Care Community. 2002 Jul;10(4):247-53. doi: 10.1046/j.1365-2524.2002.00365.x. PMID: 12193168.
Workman SR. The importance of establishing a rapport with patients. BMJ. 2013 Sep 25;347:f5745. doi: 10.1136/bmj.f5745. PMID: 24068722.
Appendix 1. Summary Table
| PICKER PRINCIPLES OF PERSON-CENTERED CARE | Pre-Assessment / Assessment | Treatment | Follow Up | Ongoing Care |
| Access to care and reliable advice | Address accessibility needs
Put support in place |
Address accessibility needs
Put support in place |
Address accessibility needs
Put support in place |
Address accessibility needs
Put support in place |
| Effective treatment by trusted professionals | Active listening
Empathy Communication |
Active listening
Empathy Communication |
Active listening
Empathy Communication |
Active listening
Empathy Communication |
| Continuity of care and smooth transitions | Note needs and preferences for other audiologists to use
Good communication between MDT services Good record-keeping |
Note needs and preferences for other audiologists to use
Good communication between MDT services Good record-keeping |
Note needs and preferences for other audiologists to use
Good communication between MDT services Good record-keeping |
|
| Involvement and support for family and family-centred care | Involve communication partner in needs assessment and goal-setting
Reiterate importance of involving communication partner in appointments |
Involve communication partner in discussion of expectations, the rehabilitation process, and support services | Involve communication partner in outcome review
Ask about the impact of management on the communication partnership |
Encourage communication partner to remain engaged with management |
| Clear information communication and support for self-care | Consider tools to help understanding of assessment and test results
Signpost for extra help and information |
Check patient can use technology – re-teach if necessary
Signpost for extra help and information |
Consider tools to assess where patient requires additional support with device management
Use questionnaires or speech testing to counsel on outcomes Signpost for extra help and information |
Encourage continued self-management and provide support as needed
Encourage patient and communication partner to take ownership of IMP |
| Involvement in decisions and respect for preferences | Discuss ALL needs
Individualise testing Discuss ALL treatment options Debrief with relevance Individualise management plan Keep plan flexible Provide copy of IMP |
Check for changes in needs or goals and adjust management accordingly
For hearing device fitting – use verification methods as starting point but make adjustments based on feedback Consider additional features as appropriate |
Check for changes in needs or goals and adjust management accordingly
Jointly review IMP |
|
| Emotional support, empathy and respect | Ask about motivations
Ask about non-auditory issues Discuss psychosocial impacts of hearing loss Consider effect of multiple chronic conditions |
Discuss any changes to psychosocial impacts of hearing loss
Consider whether care from other provider is needed. If so, refer patient to GP. |
||
| Attention to physical and environmental needs | Assess access needs prior to initial appointment, document them in the patient record, and ensure they are used at every contact | Check and apply individual access needs | Check and apply individual access needs |
- Share:
-
-
-
