By Brian Taylor, AuD, Editor-at-Large
As providers gear up for the FDA’s codification of over-the-counter (OTC) hearing aids, there is chatter on social media about how customization will remain a primary advantage of the delivery of care, in person, by licensed providers.
Besides earmolds, of course, several acoustic parameters such as gain and compression have been customized by providers for years. And, thanks to the wonders of machine learning, a growing number of hearing aids enable their wearers with the help of a smartphone to customize these acoustic settings in real time.
Customizing the Hearing Aid Fitting
Given all the ways hearing aid fittings can be customized using technology, one area that doesn’t get much attention is the hearing aid orientation of a first-time wearer. This routine act of teaching a patient how to use and acclimate to their new hearing aids.
By force of habit, most providers approach the hearing aid on-boarding process the same way: Carve out 30 to 45 minutes of time during the initial fitting to meticulously review a standard set of directives on use, care and expectations of the patient’s newly purchased devices.
MarkeTrak survey data support this assertion: First-time hearing aid wearers, on average, receive just under an hour of generic instruction, often spread over multiple appointments, on how to use their hearing aids.
Most of this instruction, we know, is verbal in nature. Some patients even describe this process as information dumping, as 25 to 65% of relevant hearing aid information needed to master the use of their devices is forgotten within four weeks of initial use.
In addition to verbal directives, all hearing aid wearers are issued standardized instructional booklets as a supplement to the advice given to them by the provider. Research suggests that these instructional booklets issued by providers (and required by the FDA to be included in the sale of a new hearing aid) offer little additional patient benefit. Reports suggest these booklets use cumbersomely small font size, overly technical language and too much text.
Counseling New Hearing Aid Users: How Effective is Current Approach?
Clearly, the common method of on-boarding new hearing aid wearers – in which all patients are given the same set of instructions and support materials, delivered in the same rote manner – is inadequate. Just how much of a lost opportunity does failing to customize the hearing aid on-boarding process present? It could be a lot. A 2013 study, for example, suggests 40% of older hearing aid wearers report low confidence in their ability to manage their devices.
Lacking the confidence to self-manage their devices, many patients fail to at a minimum to derive optimum benefit, while others probably become so frustrated with their inability to wear their devices that they end up placing them in a drawer.
The root cause of these failures has nothing to do with the sophisticated nature of hearing aid technology, instead these failings are probably a result of inadequate provision of information to hearing aid wearers over the course of initial use.
Recently, two studies from a group of Australian audiologists shed light on the inadequacies surrounding hearing aid orientation during the initial 30 to 60 days of use. Lead author Bec Bennett and her colleagues at the University of Western Australia and the University of Queensland used something called concept mapping to better understand, from both the patient’s and clinician’s perspective (a.) what hearing aid wearers need to know to effectively benefit from their devices and (b.) how do hearing aid wearers acquire this knowledge.
In the first study, published in March 2018 at the American Journal of Audiology, the researchers determined there are six tasks or skills that new hearing aid wearers must master to optimize the results of their fitting. These six skills or tasks are:
- Daily hearing aid use
- Hearing aid maintenance and repairs
- Learning to come to terms with hearing aids
- Communication strategies
- Working with your clinician
- Advanced hearing aid knowledge.
In practical terms, the findings of this study tell clinicians they need to focus their on-boarding efforts on beefing up patients’ skills in these six areas.
In their companion article, published in June at JAAA, Bennett and her colleagues used a research protocol, similar to the one mentioned above, to examine how hearing aid users acquire knowledge to develop these six skills and tasks.
What they found was that hearing aid wearers acquire hearing aid mastery skills and knowledge in three primary ways:
- Training that comes directly from the clinician
- Through the patient-clinician relationship
- Hands-on experience.
This vein of research has some useful clinical implications. First, it narrows to six the skills and tasks that need to be mastered during the initial months of hearing aid use to achieve optimal benefit. Second, the mere provision of information, presented in a standardized way, is not enough. Clinicians must strive to package information to patients in ways that make sense for them. Simply conducting a rote, 45-minute monologue and handing the patient an instructional brochure as a supplement to this monologue is woefully inadequate.
Third, and most critical, Bennett and her colleagues have uncovered an area of patient care that is ripe for customization. But perhaps because it does not involve a technological solution, it is easy to ignore or overlook. Customization of the hearing aid orientation and on-boarding process requires implementing patient centered care principles, such as shared decision making.
This recent post by Kris English demonstrates how shared decision making could be applied to a routine hearing aid orientation appointment, creating an interaction between the patient and provider that is far more meaningful and engaging for both parties.
Improving the On-Boarding Process for New Hearing Aid Users
Beyond the basic blocking and tackling of utilizing shared decision making in the clinic, customizing the hearing aid on-boarding process includes creating your own branded instruction booklet using many of the tenets suggested by Caposecco and her colleagues, provision of information in smaller chunks that are archived and accessible through YouTube, the use of audiology assistants to guide the hands-on learning process, and finally, adding to a clinic’s super bill a separate, billable fee for hearing aid skill training – even patients who are not fitted in your clinic could benefit from this customizable, patient centered service that is part of a more comprehensive rehab package.
We live in an age when it is easy to become quickly enamored by technological solutions, and for good reason: Hearing aids with their use of Bluetooth-enabled streaming, machine learning and AI-driven algorithms have never been better.
Of course, these innovations have their place and need to be fully embraced, but sometimes innovation can be as simple as respecting the unique learning capabilities of each patient and having a willingness to package information in a way that respects those bounds.
Brian Taylor, AuD, is the director of scientific and product marketing for Sivantos. He is a veteran of the hearing industry with more than 25 years of experience, most recently at Fuel Medical Group where he served as Director of Clinical Audiology. An Audiologist since 1991, Brian received his Au.D. from Central Michigan University in 2006. During his career, Brian has been involved in many areas of the industry including clinical practice, practice and professional development, and training. Brian is a prolific and respected contributor to the industry with more than 25 publications and numerous speaking engagements both domestically and internationally. He has written and edited six textbooks, and recently authored Interpersonal Audiology: A concise guide to the functional communication assessment in 2019. Brian served as Editor-In-Chief at HHTM from 2018-2019 and currently serves as Editor-at-Large.
