As previously reported in
The Hearing Review, Phonak has convened a select group of hearing healthcare experts to provide evidence-based recommendations to hearing care providers on how to better engage family members. The objective of this group is to facilitate family involvement throughout the hearing remediation process. This is the first interview of a series that will look into various aspects of Family-centered Care.
Family-centered Care is a hot topic in the context of audiolog. Can you tell me why it’s important?
Family-centered Care is an extension of patient-centered care. It places emphasis on the role of family and acknowledges the patient and their family members as the unit of care, rather than just the patient. This means that the patient, their family members, and the clinician are all partners in the planning, execution, and monitoring of treatment. In the context of Family-centered Care, “family” is a broad concept that includes anyone who plays a significant role in an individual’s life. Family-centered Care in audiology emphasizes that a patient’s hearing care decisions should be contextualized in terms of a patient’s broader life experiences. Involving family members in appointments allows a clinician to gain insight into the life experiences of the patient with hearing impairment and how their hearing affects communication in a broader sense. Taking this into account means that all individuals are in a better position to set goals and make decisions which will lead to positive outcomes. It also recognizes that family members impacted by a loved one’s hearing impairment can experience third-party disability.
What do you mean with third-party disability?
Third-party disability is defined as the disability of family members due to the health condition of their significant other. It was recognized by the World Health Organization (WHO) that although a family member may not have a health condition, they may experience impairment, activity limitations, and participation restrictions as a result of the health condition of their significant others. I think we as clinicians and researchers all agree that hearing impairment can lead to third-party disability, so involving the significant others who are affected by their family member’s hearing impairment brings positive benefits to everyone.
Can you tell me a little more about these benefits?
From research in medicine and other health sciences, we know that Family-centered Care results in better health outcomes, compliance with treatment recommendations, and greater satisfaction with the medical services provided. Family-centered Care research in audiology has shown that family involvement can encourage patients to seek help and take up hearing aids, increase their confidence in managing their hearing impairment and hearing aids, and provide valuable emotional support for the patient. We also know that, for family members, their involvement can lead to reduced third-party disability and improve the quality of the relationship. It is now recognized that hearing impairment has a detrimental effect on not only communication, but also on the wider health and well-being of the individual. Addressing hearing impairment in a holistic manner means we can have a positive impact on patients social and emotional, cognitive, and physical well-being. The benefits of Family-centered Care also extend to the clinician and other staff in the clinic in terms of greater job satisfaction. However, to achieve all these benefits, Family-centered Care should be a whole-of-clinic approach.
Can you elaborate on the phrase “whole-of-clinic?”
Individually, audiologists can make a big positive difference when they involve family members during audiology appointments. However, Family-centered Care is so much more effective when it is implemented in a whole-of-clinic manner. This means everyone, including management, clinicians, and front-of-house staff are aware of, and practice Family-centered Care. It is important that management supports Family-centered Care as, to be successful, it should be part of the clinic’s organizational culture. That means that not only the clinic’s infrastructure such as space, furniture, and set-up should promote and support Family-centered Care, but so should its norms, incentives, and policies. Front-of-house staff play an important role too, in consistently asking about family members’ attendance when scheduling appointments and ensuring they are acknowledged and welcomed when they attend. Of course, clinicians also play a key role in setting the framework for Family-centered Care during clinical appointments. This can be done, for example, by letting all individuals (patients and families) know they will be given the chance to actively participate in the whole appointment. This is particularly important at the start of the appointment. Allowing all individuals present in the appointment to share their experiences of the hearing impairment during history taking will provide valuable information and input to shared goal setting and decision-making as management progresses.
How can you ensure that all members of staff are aware of their role in promoting Family-centered Care?
The aspect of awareness is key to successful adoption of Family-centered Care. This means all staff should have access to training and other resources that educate about what Family-centered Care is and why it is a benefit for patients and their families, as well as for audiology outcomes and staff satisfaction. Once the clinic staff are aware of the benefits of Family-centered Care, it should also be an item on regular staff meeting agendas to keep its implementation a focus.
You have been involved in research around the topic of Family-centered Care in audiology for several years now. What are some of your latest findings?
I am lucky to be a member of a research group at the University of Queensland, in Australia, that has had Family-centered Care as one of its focus areas for many years now. Over 15 years ago, members of the research group such as Professor Louise Hickson and Associate Professor Nerina Scarinci, developed Active Communication Education or ACE, an interactive group communication education program for individuals with hearing impairment and their family members. The ACE program’s aim is to improve communication and reduce participation restrictions for older adults with hearing impairment, and the developers of the program recognized that, to do this, it was important to include significant others. The benefits of this program to both the individuals and their families has been documented and the research group has continued to investigate Family-centered Care since then.
Within the research group, we’re currently running a study which looks at implementing Family-centered Care in a number of clinics. The research is supported by Sonova and collects data from clinicians, front-of-house and management staff, patients, and family members using interviews, recordings, appointment observations, and questionnaires. This is an action research study which involves taking baseline data and using that to design two interventions aimed, at first, improving the attendance of family members in audiology appointments and second, improving their involvement in audiology appointments.
If Family-centered Care is so simple, why would it need interventions in implementing it?
Using Family-centered Care in an audiology practice means some behaviors may need to change and we acknowledge that behavior change isn’t easy. For example, the staff responsible for scheduling appointments in the clinic may not routinely ask for family members to attend and our current study has shown that it’s not so simple to say “we’ll just start asking.” We found that for some of these staff members, the word “family” was viewed as a rather emotional or sensitive term. They were uncomfortable with asking for family member attendance in case the patient had, for example, recently lost a spouse or was estranged from adult children. When we then role-played asking for a family member to attend, we found that using phrases such as “someone close to you” or “someone you talk to regularly” were both more effective in describing the person we would like to invite to join in the appointment and more comfortable phrases to use for the staff when scheduling the appointment. So this task of asking family member attendance required training to explain the benefit of family member attendance, role-playing in how to ask, and coaching to help front-of-house staff maintain the behavior change.
Did your research identify other concerns in increasing family attendance?
Yes, some of the staff members in the study were concerned about encountering resistance from patients in bringing a family member. When we explored the data from telephone calls and interviews, we found two possible reasons for this. Firstly, patients were given insufficient context or explanation for asking for family member attendance. Many patients would not usually bring someone else along to their healthcare appointments and, therefore, would not expect to be asked this question. Once we framed the question by first giving an explanation of the importance of family member involvement, the question was no longer unexpected. Secondly, some staff members avoided asking for family member attendance because they didn’t know how to respond to concerns or objections. For example, some noted that asking patients to bring someone to an audiology appointment could be overstepping boundaries, or seen to be taking control or independence away from the patient. Based on the interviews we conducted, we created sample objections and used role-playing and provided cue cards to help staff in addressing any patient concerns. We also reminded the clinicians and staff involved in the study that Family-centered Care means being responsive to individual needs and respecting the wishes of the patient. This includes allowing the patients to define who will be the active participants in their hearing care management.
Where can I find out more about this study?
The study is ongoing and not yet published. Early indications show that family attendance is increasing, from 30% of appointments to 50% of appointments after the first intervention, but this is preliminary and we will continue with the study until the end of this year. There are, however, a range of useful resources if you’re interested in Family-centered Care in audiology. In Hearing Review, there are articles including 10 suggestions for the implementation of Family-centered Care and a 10-step audit to assess how family-centered your clinic is. These articles are part of a series published by members of an expert panel convened by Phonak to facilitate family involvement throughout the hearing remediation process. The panel also provided guidance for an accredited Family-centered Care eLearning program for hearing professionals, developed by Phonak (http://elearning.tools.phonakpro.com/FCC).
Additional Resources on FCC
The Hearing Review
has published a series of key articles related to the FCC approach, including:
Family-centered Adult Audiologic Care: A Phonak Position Statement. By Gurjit Singh, PhD; Louise Hickson, PhD; Kris English, PhD; Sigrid Scherpiet, PhD; Ulrike Lemke, PhD; Barbra Timmer, MACAuD; Ora Buerkli-Halevi, MS; Joseph Montano, EdD; Jill Preminger, PhD; Nerina Scarinci, PhD; Gabrielle H. Saunders, PhD; Mary Beth Jennings, PhD, and Stefan Launer, PhD. Apr 2016 Hearing Review.
Family-centered Audiology Care: Working with Difficult Conversations. By Kris English, PhD; Mary Beth Jennings, PhD; Christopher Lind, PhD; Joseph Montano, EdD; Jill Preminger, PhD; Gabrielle Saunders, PhD; Gurjit Singh, PhD; Elizabeth Thompson, AuD. August 2016 Hearing Review.
Family-centered Audiology Care: Making Decisions and Setting Goals Together. By Louise Hickson, PhD; Christopher Lind, PhD; Jill Preminger, PhD; Brittany Brose, AuD; Rebecca Hauff, and Joseph Montano, PhD. Nov 2016 Hearing Review.
Family-centered Audiology Care: How Do I Implement Family-centered Care in My Practice? By Bettina Turnbull, MAud. December 2016 Hearing Review.
Family-centered Audiology Care: Working with Partners Reporting “Incongruent” Hearing Aid Outcome, by Gabrielle Saunders, PhD, Jill Preminger, PhD, and Nerina Scarinci, PhD. February 2017 Hearing Review.
Family-Centered Audiology Care: Emotion and Reason in Hearing Healthcare. By Gurjit Singh, PhD; Caitlinn Barr, PhD; Joseph Montano, EdD; Kris English, PhD; Frank Russo, PhD, and Stefan Launer, PhD. May 2017 Hearing Review.
About the Author: Barbra Timmer, PhD, MBA, MAudA (CCP) is Senior Scientist at Sonova AG and Adjunct Senior Research Fellow in the School of Health and Rehabilitation Sciences at the University of Queensland, Australia. Before starting her research career, Barbra worked in clinical audiology in Australia and the Netherlands and gained hearing health industry experience in Switzerland. Her current research interests include the real-world challenges and audiological outcomes for adults with hearing impairment, teleaudiology and mHealth, training interventions for adults with hearing and balance issues, and the implementation of Family-centered Care in audiological practice.
For more information about Family-centered Care please visit: www.phonakpro/fcc