Family-Centered Care, Clinical Practice

Family connections can improve the health and well-being of your patients

In studies looking at reducing mortality risk factors, maintaining social ties is ranked higher than quitting smoking, drinking less and doing exercise. Learn more about the importance of social connections in this interview with Professor Louise Hickson.

Interview series

Theory to Practice

Interviewee
Louise Hickson
Professor of Audiology, University of Queensland, Australia

Professor Hickson is recognized internationally as a leader in audiology research and practice. She is committed to improving the lives of adults with hearing loss and finding best practice interventions to help them. She has over 230 publications including 4 books and 18 book chapters. Prof Hickson is Chair of the Phonak Expert Circle on Family Centered Hearing Healthcare.

When it comes to family-centered care, Professor Louise Hickson is the go-to expert. She recently presented at the ‘Hearing well and being well – a strong scientific connection’ conference in Frankfurt and her presentation titled, ‘Key role of families in hearing well and being well’ was filled with eye-opening evidence on the importance of social connections. Some of the key highlights are included in this interview. Happy reading!

 

Here is our interview….

Hello Louise, we have heard the term ‘social cure’ being used. Can you tell us what that means and how it relates to hearing well?

The ‘social cure’ in psychology refers to the fact that social support and social integration are central to quality of life for all adults. Humans are social beings and the most important thing they can do for their physical and mental health is to connect to other humans in the world around them.

A best-selling book called “The New Psychology of Health: Unlocking the Social Cure” by Professor Cath Haslam and colleagues from The University of Queensland makes a strong evidence-based case for the fundamental importance of social connections, particularly through groups, for addressing health-related changes associated with aging, as well as conditions such as depression, trauma and addiction.

How important are social ties?

Group membership that is meaningful is the key. We are not ‘tied’ to others merely by joining a group. We need to develop a sense of ‘us’ to reap the benefits. To demonstrate the importance one needs only to look at the results of studies of mortality risk factors and social ties is ranked higher than things like quitting smoking, drinking less, losing weight and doing exercise.

Once people are at retirement age, how important is it that the number of social groups they are in does not decline?

A study reported in the BMJ Open in 2016 really brought home this point. Steffens et al. looked at risk of death in the first 6 years after retirement in a sample of more than 400 people. They found that if people maintained the same number of groups after retirement they had a 2% risk of death 6 years later. If they dropped out of 1 group the risk rose to 5% and if they dropped out of 2 groups the risk increased significantly to 12%. Retirement from full-time work is obviously a pivotal point in people’s lives and this study shows the critical nature of maintaining social connections around that time.

…maintaining social groups is also beneficial to maintaining cognitive abilities with age”

Wow, increased risk of death is certainly a good reason to focus on maintaining social groups as we age. Does being involved in social groups have other benefits to our health?

Yes – maintaining social groups is also beneficial to maintaining cognitive abilities with age. The relationship between hearing and cognition is such a hot topic in audiology that this relationship is very important for us to understand. Basically, the more groups someone is part of, the better their cognition. People aged 80 with extensive group ties have, on average, a cognitive age that is 20 years better than people with limited social ties. The authors of that research led by Professor Haslam therefore talk about group life being protective of cognitive decline. They suggest that group membership should be ‘prescribed’ to improve health in older adults and have developed a program called “Groups4Health” to do just that. More information can be found at http://www.groups4health.com/.

How important are families in hearing healthcare?

I have been working for some time as a researcher and advocate for the key role of families in hearing health care and this social cure research has just reinforced for me how important they are! Social connections are the ‘cure’ and the most common social connection is with family. They are an essential link between hearing well and being well.

Extensive research shows that family help people with hearing loss to:

  • seek help
  • make decisions about what to do about their hearing loss
  • purchase hearing devices
  • be successful with hearing devices

Why?? Because the social connection between a person with hearing loss and their family REALLY matters. Both value it and both are impacted by hearing loss as it negatively impacts communication which is central to social connection. Practicing FCC will help adults with hearing loss to hear well and be well by facilitating successful group connections.

How should we define family when we want to implement FCC?

FCC is best practice in health care of any kind and family is defined as two or more persons related in any way: through a continuing biological, legal or emotional relationship.  Any individual who plays a significant role in an individual’s life is ‘family’. I wonder if audiologists need to think more broadly about who are their patients’ families?

In your research, do you know how often family members are attending appointments?

We know from a number of studies that the only way hearing care professionals are connecting with family is if the family attend appointments. Our results from public and private clinics in Australia show that this is only happening about 30% of the time.

How can audiologists practice FCC?

FCC needs a whole of clinic approach. The front of house staff and audiologists both need to welcome family. Set up the clinic waiting area and offices to welcome family – have chairs for them, reading material for them, family pictures on the walls. Think about when you have gone as a family member to a medical appointment and felt welcomed – What did you see? What did people say? How were you included?

Front line staff are key to increasing family member attendance in the clinics”

When it comes to training front line staff, what needs to be done?

Front line staff are key to increasing family member attendance in the clinics. They need education coaching to achieve this and the commitment and support of the audiologists in the clinic. In terms of education they should understand the ‘why’ of using FCC. In terms of coaching, role play and regular reminders are important. Change isn’t easy for anyone and ongoing support and encouragement is needed.

We have worked with front of house staff when talking on the phone to patients to:

  • Ask an explicit question e.g., ‘Will you be bringing anyone to the appointment?’ ‘Is there anyone you can bring to the appointment?’
  • Use encouragement e.g., ‘We do recommend that you bring someone along.’
  • Use supporting arguments or evidence if needed e.g. ‘…because this helps us provide a more comprehensive assessment’ ‘….because hearing loss affects communication with people around you’

What are intervention targets for training clinicians?

We have done similar education and coaching with clinicians but the targets for change have been different. In the appointments we are asking them to:

  • Set an agenda for the appointment that includes both people, e.g., ‘Today I’m going to ask you both some questions about the communication difficulties you experience in your daily life.’ Make it clear that everyone gets a turn to talk.
  • Seek and actively listen to family members’ contributions e.g., ‘How do you see things from your perspective?’ Listen to what they say in response.
  • Use a decision aid or collaborative goal setting tool.

Finally, can you give us 3 recommendations of how hearing care professionals can use these learnings to change their practice this Monday morning?

  1. Put FCC on the agenda of your next staff meeting. Find out what everyone in your clinic really thinks about it.
  2. Look at the physical set up of your clinic room and make one change so that it is more FCC than it is currently.
  3. Take a small step yourself by asking any family who attend your clinic on Monday morning at least one open-ended question during the appointment about how their perspective on either hearing loss or hearing aids. You may be surprised by what you learn!

Thank you very much Louise. You’ve provided some wonderful insights for clinicians on the important role of families, both in and out of the clinic!

About

Theory to Practice is a series of interviews with experts in the field of audiology and beyond. Interviewees share their knowledge and insights on relevant topics. The special focus of each interview is to translate theory into key take-aways which can be implemented into daily practice.

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