Audiologists often place patient counseling into two categories: 1.) Informational counseling, which primarily focuses on educating patients and their families about test results, the consequences of untreated hearing loss and the role of hearing aids for treating it. 2.) Personal adjustment counseling, which describes how audiologists help patients deal with the emotional and social impact of their hearing loss, as well as guiding patients through the process of addressing internal challenges associated with their long-standing condition.
A recent review of audiological counseling literature, by audiologists at Utah State University, published online in the International Journal of audiology, shows the bulk of research in this area has been devoted to informational counseling. Today, however, for a variety of reasons, audiologists are beginning to rely more on personal adjustment counseling, rather than informational counseling, when working with adult patients. This shift is reflected in the growing number of excellent research papers, academic posters and AO webinars, devoted to personal adjustment counseling, motivational interviewing techniques and hearing loss self-management skills, all of it falling under the rubric of patient centered care..
There are a few reasons the emphasis is shifting from informational to personal adjustment counseling. One, the internet allows a growing number of people, including many non-tech savvy older adults to gather information about their condition without assistance from a professional. Two, informational counseling can be conducted by just about anyone who is willing to learn some basic information about hearing loss and treatment options. Thus, the role of the audiologist with respect to informational counseling can be replaced with an assistant, or supplemented am automated, computer-based decision aid.
Perhaps the most important driver of the movement toward emphasizing personal adjustment counseling is that despite the advent of self-fitting hearing aids, audiologists are beginning to quickly recognize personal adjustment counseling skills cannot be replaced by computer algorithms, decision aids or even lesser trained audiology assistants. And, if a service, like personal adjustment counseling, cannot be duplicated by others, and it is beneficial to patients, there is a good chance audiologists can charge for it.
While clinical audiologists wait for researchers to publish well-designed studies evaluating the effectiveness of personal adjustment counseling, the paucity of studies identified by Meibos at colleagues that have previously addressed the topic of personal adjustment counseling suggest audiologists are beginning to shift more of their attention to implementation of the chronic care model of service delivery.
Personal Adjustment Counseling in Audiology
To work successfully under the chronic care model, in which the primary role of the audiologist is to address the social, psychological and emotional barriers associated with hearing loss (while simultaneously embracing the medical model in which disease detection using the standard audiometric test battery is still essential) it would be sensible for audiologists to do the following:
- Spend sufficient time with patients in need of hearing aid and other related rehab services. Remember that what works in the medical model for disease detection: precision, accuracy and efficiency in conducting a test battery, is ineffective in the chronic care model, where time spent with patients and improvisational communication skills are necessary. For patients in need of a Communication Assessment, give them adequate “face time” so they can process new information, ask questions and talk about their personal experiences coping with hearing loss. If need be, spread this time out over multiple visits, rather than rushing through an appointment, wishfully thinking it will result in an immediate hearing aid sale.
- Provide an atmosphere in your clinic where patients feel comfortable discussing their feelings and emotions and the audiologist can validate those feelings in an empathic manner. Take a course on Motivational Interviewing or watch the recent 2-part Audiology Online webinar on the topic by Dave Citron and Mike Harvey.
- Use effective patient-provider communication skills, including good eye contact and reflective listening. A reasonable place to learn the basics is through the Cleveland Clinic REDE model of communication. The REDE communication model is helpful because it considers the barriers of modern communication, which are a lack of time and the use of computers to document information, and provides simple, humanistic strategies to overcome these barriers.
Soon, as more patients realize they can self-direct their care, use self-fitting hearing aids, and maybe even completely avoid seeing a hearing care professional, audiologists must identify additional services that are valued by the market.
Honing your personal adjustment counseling skills will undoubtedly gain popularity in clinics that want to differentiate their services from self-directed, tele-care options. Pay attention to the burgeoning literature in this area and put the findings into action!
Alex Meibos, Karen Muñoz, Jared Schultz, Tanner Price, John J. Whicker, Ana Caballero & Laurel Graham (2017) Counseling users of hearing technology: a comprehensive literature review. International Journal of Audiology, 56:12, 903-908
*featured image courtesy health.mil