The pivotal role of family in making healthcare related decisions

The importance of family-centered care keeps ‘popping up’ as I proceed in my auditory rehabilitation (AR) research. Here is some background:

Currently, I am looking into the value of ‘Decision Support’ as a method to help adults with hearing loss make a decision about AR services. For example a decision could be:

• I think I am having hearing problems; should I go see an audiologist, or just continue as I am?
• My audiologist has recommended a hearing aid; should I try a hearing aid, try to get a less expensive device over the internet, or continue as I have been?

Most audiologists are already familiar with Shared Decision Making and hopefully use this practice in your clinic. Shared decision making is a process in which the audiologist works together with the patient to define the problem (e.g., what should be done about the hearing loss), provide information (the audiologist gives information about device and communication options, the patient gives information about his/her communication needs, experiences and preferences), and then together the audiologist and patient develop a management plan. Decision aids are very useful in helping a patients to participate in the AR process. For example, a decision aid for AR could compare a few different management options such as hearing aids, auditory training, and hearing assistance technologies to taking no action. The decision aid can see simply describe the steps taken to implement each option, along with the benefits and limitations of each. See Laplante-Lévesque (2010) for more information and an example.

Decision support available in different forms

Some patients, however, are not prepared to make a decision about a management plan. Many of these individuals could benefit from decision support in the form of ‘Decision Coaching’. A coach is a person, a printed guide or an internet delivered program that help a patient to:

1. Understand that there is a decision to be made.
2. Comprehend information about their options.
3. Clarify their values (what are patient’s beliefs on what matters most to him/her and to figure out their own understanding of the benefits and drawbacks of each option).

A decision coach guides an individual through these three steps using clear and direct language.

Significant others integral to decision making

I have been using the Ottawa Decision Support Framework to develop a decision coaching guide. When I first discovered this framework I was delighted to see that significant others (which includes family members, friends, and partners) are considered to be an integral part of the decision coaching process. Specifically, the patient is asked to consider how a significant other can offer support in comprehending information and clarifying values. It is noted that discussing the decision with a trusted partner can help individuals to understand their options and to clarify their own beliefs. In the Ottawa Personal Decision Guide, patients are also asked to consider if they are being pressured by a significant other as to what decision to make.

The audiology literature has also shown that family members can pressure their partners with hearing loss to take-up hearing aids or to reject hearing aids (e.g. see Wallhagen); supportive family members can increase the uptake of hearing aids, whereas unsupportive family members can discourage their use.

How might you turn unsupportive family members into those that understand the benefit of hearing aid use?   I invite you to add your insights in the comment section below.

 

To explore this topic further:

To read more on shared decision making you can start here: Laplante-Lévesque, A., et al. (2010). “A qualitative study of shared decision making in rehabilitative audiology.” Journal of the Academy of Rehabilitative Audiology 43: 11 – 26.

For more information on Decision Coaching and the Ottawa Decision Guide for Two: https://decisionaid.ohri.ca/

Wallhagen, M. I. (2010). “The stigma of hearing loss.” Gerontologist 50(1): 66-75.