Measuring the effectiveness of an audiological counseling program
TL;DR: Results suggest that a six-week program is effective in helping clinicians change their counseling skills within their practice.
Abstract: Objective: Audiologists routinely observe patients struggle with psycho-emotional difficulties associated with hearing loss, yet are often underprepared to manage this vital aspect of patient care....
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TL;DR: 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 and found that patient-centered communication was rarely observed in initial audiology consultations.
Abstract: 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.
100 citations
Additional excerpts
...Audiologists may have a good theoretical understanding of the need to address psychosocial concerns to facilitate behavioral change, given the extensive literature to this effect (Gagne and Jennings, 2011; Preminger and Meeks, 2012; English and Archbold, 2014); however, findings of this study indicate that this does not transfer to clin ical practice....
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TL;DR: This scoping review cataloged the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psychological intervention.
Abstract: Background: Tinnitus is associated with depression and anxiety disor- ders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiolo- gists across the whole UK public healthcare system and similar systems elsewhere across the world.
Objectives: The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psy- chological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature.
Design: The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, disserta- tions, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews—of the search results. Records were included in which a psy- chological therapy intervention was reported to address adults (≤18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the intervention included biofeedback, habituation, hypnosis, or relaxation as necessary parts of the treatment.
Results: A total of 5043 records were retrieved of which 64 were retained. Twenty-five themes of components that have been included within a psychological therapy were identified, including tinnitus educa- tion, psychoeducation, evaluation treatment rationale, treatment plan- ning, problem-solving behavioral intervention, thought identification, thought challenging, worry time, emotions, social comparison, inter- personal skills, self-concept, lifestyle advice, acceptance and defusion, mindfulness, attention, relaxation, sleep, sound enrichment, comorbid- ity, treatment reflection, relapse prevention, and common therapeutic skills. The most frequently reported psychological therapies were cogni- tive behavioral therapy, tinnitus education, and internet-delivered cogni- tive behavioral therapy. No records reported that an audiologist delivered any of these psychological therapies in the context of an empirical trial in which their role was clearly delineated from that of other clinicians.
Conclusions: Scoping review methodology does not attempt to appraise the quality of evidence or synthesize the included records. Further research should therefore determine the relative importance of these dif- ferent components of psychological therapies from the perspective of the patient and the clinician.
44 citations
Cites background from "Measuring the effectiveness of an a..."
...Indeed, the value of a training program to develop audiologist’s counseling skills for working with patients with hearing loss has recently been demonstrated (English & Archbold 2014)....
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TL;DR: Training in and the provision of psychological support for tinnitus patients by audiologists is particularly a concern for Scotland and Northern Ireland and has implications for the person-centeredness of audiology services.
Abstract: Rationale, aim and objective: Chronic tinnitus is a prevalent condition broadly managed using individualised sound-based interventions, individualised or group education, counselling, or cognitive therapies. In the UK, therapy is largely delivered by audiologists or hearing therapists and, where available, clinical psychologists and physicians. Changes in the structure of the health service necessitate ongoing evaluation to monitor equity and person-centeredness of care. The purpose of the current evaluation was to describe provision and explore diversities in the services provided for tinnitus patients across the four countries of the UK and consider these relative to current commissioning and clinical practice guidelines. Method: A 37 item questionnaire was devised and distributed via email and social media to reach audiology departments in the UK and 147 valid responses were acquired during the 3 month period of the evaluation. Results: The structure and provision of tinnitus services varies widely across the four countries of the United Kingdom in terms of which clinicians provide the services. Outside of England there was no report of clinical psychology or audiovestibular physician involvement in services. There is also variability in access to psychological therapy or support (little training in CBT in Scotland and none in Northern Ireland), self-help groups (little involvement but interest from clinicians) and devices (e.g., one quarter of departments do not currently offer combination hearing aid devices for tinnitus). Clinicians are increasingly using validated questionnaires to evaluate the effectiveness of tinnitus management in their departments. Conclusions: Training in and the provision of psychological support for tinnitus patients by audiologists is particularly a concern for Scotland and Northern Ireland and has implications for the person-centeredness of audiology services. Capacity and need for research in paediatric tinnitus, combination devices, non-ear level sound devices and audiologist-delivered psychological therapy, are noted.
37 citations
TL;DR: The need for a greater focus on communication skills training in the audiology curriculum with particular attention paid to information giving strategies and patient-centredness is suggested.
Abstract: Objective: Patient recall and understanding of information provided during feedback sessions may impact on adherence to treatment recommendations and may be affected by the audiologist's information giving style. This study examined patients’ recall and understanding of diagnostic audiological information provided in a feedback session after an initial assessment. Design: An exploratory, qualitative research design was used and involved: (1) observation of audiological assessments; (2) video recording of feedback sessions between audiologists and patients; (3) audio recorded semi-structured interviews with participants. Transcription-less analysis was used for the videoed interactions and content analysis for the interviews. Study sample: Participants included five adult second-language English speaking patients and five audiologists at an audiology clinic. Results: Patients correctly recalled and understood diagnoses and recommendations but struggled to recall other information provided. There ap...
18 citations
Cites background or methods from "Measuring the effectiveness of an a..."
...In this study, patient concerns did not seem to be a major focus in the interactions, nor were patient expectations of the feedback session enquired about and addressed by the audiologists (English & Archbold, 2014)....
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...Approaches such as the ‘ distributed over time learning model ’ adopted by the Ear Foundation could assist in translating new skills into sustainable changes in clinical practice (English & Archbold, 2014)....
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...During such interactions, audiologists need to maintain an empathetic environment (English & Archbold, 2014; Grenness et al, 2014)....
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01 Jan 2018
17 citations
Cites background from "Measuring the effectiveness of an a..."
...English and Archbold (2014) explored how a 6-week seminar training might influence audiologic counseling practices in the United Kingdom....
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References
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TL;DR: Using Bloom's Taxonomy to Write Effective Learning Objectives: The Abcds of Writing Learning ObjectIVES: A Basic Guide.
11,097 citations
01 Jan 1956
2,707 citations
TL;DR: The data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes.
Abstract: ContextAlthough physicians report spending a considerable amount of time in
continuing medical education (CME) activities, studies have shown a sizable
difference between real and ideal performance, suggesting a lack of effect
of formal CME.ObjectiveTo review, collate, and interpret the effect of formal CME interventions
on physician performance and health care outcomes.Data SourcesSources included searches of the complete Research and Development Resource
Base in Continuing Medical Education and the Specialised Register of the Cochrane
Effective Practice and Organisation of Care Group, supplemented by searches
of MEDLINE from 1993 to January 1999.Study SelectionStudies were included in the analyses if they were randomized controlled
trials of formal didactic and/or interactive CME interventions (conferences,
courses, rounds, meetings, symposia, lectures, and other formats) in which
at least 50% of the participants were practicing physicians. Fourteen of 64
studies identified met these criteria and were included in the analyses. Articles
were reviewed independently by 3 of the authors.Data ExtractionDeterminations were made about the nature of the CME intervention (didactic,
interactive, or mixed), its occurrence as a 1-time or sequenced event, and
other information about its educational content and format. Two of 3 reviewers
independently applied all inclusion/exclusion criteria. Data were then subjected
to meta-analytic techniques.Data SynthesisThe 14 studies generated 17 interventions fitting our criteria. Nine
generated positive changes in professional practice, and 3 of 4 interventions
altered health care outcomes in 1 or more measures. In 7 studies, sufficient
data were available for effect sizes to be calculated; overall, no significant
effect of these educational methods was detected (standardized effect size,
0.34; 95% confidence interval [CI], −0.22 to 0.97). However, interactive
and mixed educational sessions were associated with a significant effect on
practice (standardized effect size, 0.67; 95% CI, 0.01-1.45).ConclusionsOur data show some evidence that interactive CME sessions that enhance
participant activity and provide the opportunity to practice skills can effect
change in professional practice and, on occasion, health care outcomes. Based
on a small number of well-conducted trials, didactic sessions do not appear
to be effective in changing physician performance.
2,384 citations
TL;DR: In this article, the authors link patient treatment adherence to physician-patient communication and meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians.
Abstract: Background:Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians
1,975 citations
TL;DR: Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients and is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits.
Abstract: Background
Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.
Objectives
To assess the effects of educational meetings on professional practice and healthcare outcomes.
Search methods
We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.
Selection criteria
Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.
Data collection and analysis
Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.
Main results
In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.
Authors' conclusions
Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.
1,579 citations
"Measuring the effectiveness of an a..." refers background in this paper
...It is a truism of human nature that ‘ change is hard, ’ but when change brings positive results, changes can become the ‘ new normal ’ (O ’ Brien et al, 2001)....
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...O ’ Brien et al, 2001; Penuel et al, 2007), such steps have not yet been applied to audiology....
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