Finding Your Way With GPS: The Role of the Communication Partner in Goal Setting and Treatment Planning
Navid Taghvaei, Au.D.
This tutorial provides how-to guidance and insights on navigating the goal setting and treatment planning process in a way that provides a deeper level of engagement between the audiologist, person with hearing loss and communication partner.
Mr. Smith is a 76-year-old retired professor who was recently fitted with hearing aids. Based on his hearing and health history, Mr. Smith has been struggling with his hearing loss for more than 20 years. Although his wife was actively involved in the hearing aid selection and fitting process, she appears to have unrealistic expectations about Mr. Smith’s initial experience with his hearing aids. This statement is based on the audiologist’s observations during the follow-up appointments at one week and four weeks post hearing aid fitting. At both of those appointments, Mrs. Smith alluded to her disappointment with her husband’s progress. Mrs. Smith did spread the blame around, as she expressed dismay in her husband’s ability to consistently use his hearing aids. She also expressed concern that a different pair of hearing aids may be needed since his current devices, which he’s been “fool heartedly trying to use” for almost five weeks don’t seem to help him all that much in the listening situations where they are needed the most. Mrs. Smith even expressed some frustration with the audiologist, questioning if the hearing aids were properly tuned for her husband’s hearing loss. At the same time, Mr. Smith contrarily believes he is making steady progress, even though he’s not wearing the hearing aids as much as his wife would like him to use them.
This scenario represents a relatively common occurrence in many clinics. It is a situation that cries out for mediation from the audiologist who is trying to rein in a situation that has the potential to quickly degenerate into chaos. It is a situation in which the individual with hearing loss and their primary communication partner (CP) are not on the same page with respect to expectations and benefits of amplification. By the same token, it represents an opportunity for the audiologist to sort through the motivations, attitudes, and behaviors of both the person with hearing loss and their CP; in a sense to hit the re-start button and work with both parties to improve daily communication for both of them.
The objective of this tutorial is to provide some practical guidance to audiologists on the process of goal setting for the CP – an often-overlooked player in the goal setting and treatment planning process. Just how critical is the CP in the successful treatment and management of hearing loss in adults? That is a question that research helps us better understand.
More than a decade ago, the MarkeTrak VIII survey (Kochkin, 2012) found that the ‘spouse or relative’ provided substantial psycho-social influence among hearing aid nonadopters with short-term (six months to one year) hearing aid purchase intent. More than half (53%) of the individuals who had not acquired hearing aids would be motivated to adopt hearing aids if their ‘spouse or relative’ recommend them to do so. In a more recent meta-analysis, Merner et al (2023) showed that patient outcomes are improved when the person with hearing loss, their CPs, and the audiologists are all directly involved in the entire goal setting, treatment, and follow-up process. This finding is consistent with a similar evidence-based review by Kamil & Lin (2015), which highlighted the broad effects of hearing impairment on friends and family members and the importance of involving CPs in hearing loss treatment decision. In addition, goal sharing between the person with hearing loss and their CP, a process facilitated by an audiologist, has been shown to lead to better patient outcomes (Ekberg et al 2020). Finally, a retrospective explorative study by Ellis, Singh, and Launer (2023) investigated the unexplored question of whether an association exists between the type of significant other (SO) in attendance at appointments and hearing aid adoption.
The study sample consisted of adult patients from a chain of private clinics in the United Kingdom who either attended their audiology appointment with a SO or alone. Six SO types were identified and classified: partner (n = 6,608), parent (n = 76), child (n = 2,577), sibling (n = 208), friend (n = 518), and carer (n = 28). In addition to replicating previous findings which showed that significant-other attendance at audiology appointments was positively associated with hearing aid adoption, results from the current paper also revealed that the odds of hearing aid adoption were greater if the SO was of a stronger relationship tie (i.e., partners, parents, children, and siblings) and not a weaker relationship tie (i.e., friends, carers). These findings suggest that the CP in attendance for the appointment should be one who spends a significant amount of time with the person with hearing loss and should be someone with whom they have a strong, emotional bond . While these studies suggest the presence of a primary CP is critical, none provide concrete guidance on how communication partners can contribute directly to the goal setting and treatment planning phases of the so-called patient journey. Consequently, this article intends to provide some how-to guidance.
Goal-sharing for Partners Strategy (GPS) is a tool developed by the Ida Institute for audiologists to use with persons with hearing loss and CPs. The GPS is designed to help the person with hearing loss and their CP accomplish four goals:
- Acknowledge the hearing loss.
- Acknowledge the activity limitations and participation restrictions that result from the hearing loss and how the person with hearing loss and CP are both affected by them.
- Acknowledge that both parties are partners in communication with an important stake in improving outcomes of the treatment.
- Realize they have a shared responsibility in managing the hearing loss and treatment approach.
The GPS is a five-step process that audiologists can use to get both the person with hearing loss and their CP directly involved in the rehabilitation process. Step 1 entails asking both the person with hearing loss and their CP to identify key listening situations where both parties want to achieve improved communication. In order to execute step one effectively, the audiologist’s line of questioning needs to focus on what successful communication looks like to both parties. Rather than focusing on communication problems, the task of the audiologist is to help both parties “paint the picture” of effective communication in everyday listening places. A substantial part of this conversation, which is facilitated by the audiologist, needs to emphasize his capabilities, rather than his disabilities. For example, if the person with hearing loss has a physical or cognitive limitation, the audiologist needs to focus on the skills a person with hearing loss can successfully master.
Step 2 can be broken down into four questions that are asked of both parties.
- Question 1 is asked to the person with hearing loss: What problems or challenges do you experience because of your hearing loss?
- Question 2 is asked to the CP: What problems or challenges do you experience because of your partner’s hearing loss?
- Question 3 is asked to the person with loss: What problems or challenges does your CP experience because of your hearing loss?
- Question 4 is asked to the CP: What problems or challenges does your partner experience because of his hearing loss?
These four open-ended questions are designed to allow each party to reflect on their own experiences with respect to the individual’s hearing loss and to consider each other’s point of view. The intent is that each person will realize and maybe even appreciate that hearing loss is a shared condition that each person has a stake in managing.
It should be noted that the four questions posed above, under Step 2, are likely to prompt conversations about a variety of emotional topics. Because there is an emotional component to the inability to communicate, it is quite common for marital problems to be brought up during Step 2. If the scope of the conversation is moving outside the comfort zone of the audiologist, it is appropriate for the audiologist to ask the help-seeking individual and their CP to focus specifically on hearing problems.
Step 3 asks the participants to consider the hearing and communication problems they experience together. In other words, after each party has been asked to explore the problems they experience as a result of the hearing loss, the audiologist asks the couple to discuss the problems they experience together because of their hearing loss. When asking this question, it is likely the response will be related to a social situation, like a restaurant, or watching television at home. The point is to identify a communication problem or challenge that affects both parties so they can address it together.
Following Steps 2 and 3 in which a list of communication problems are noted, the next step (Step 4) involves devising a set of achievable goals for each respective problem. Like any goals, the ones set for the person with loss and the CP (with guidance from the audiologist), need to be time bound and realistic. As a general rule, one goal per problem is sufficient.
Finally, Step 5 involves the person with hearing loss, CP, and audiologist brainstorming ideas and tactics that can be used to achieve each goal. Both parties (person with hearing loss and CP) need to be actively involved in this process. It is the responsibility of the audiologist to ensure the tactics and ideas tied to each goal are understood clearly. Further, the audiologist can track progress toward the goal at each subsequent follow-up appointment.
Using this five-step process, let’s take a look at an example of how a list of goals is developed during an assessment. After a one-hour appointment, these four goals were created. In this example the husband is the person with hearing loss with the hearing loss and the wife is the CP.
- Problem #1: My husband never talks on the phone because he cannot hear.
- Problem #2: The television is very loud and that really annoys my wife.
- Problem #3: We avoid going to restaurants with other couples because my husband cannot hear them, and I get frustrated when that happens.
- Problem #4: Both of us get frustrated and agitated when I cannot hear during conversations during meals at home between the two of us.
Notice, for each statement of the problem, there is an emotional component such as frustration, annoyance, or a feeling of missing out. From this list of problems, also notice that the list is from both the person with hearing loss and the CP’s perspective, or in the case of Problems #3 and #4, it is their combined perspective.
Now, for each of the four stated problems, let’s take a look at a corresponding goals and tactics needed to achieve each goal.
Problem #1: My husband never talks on the phone because he cannot hear.
Goal: Have one conversation per week with a family member or close friend.
Tactics to Achieve Goal:
- Use Facetime or other video-based system to complete the call.
- Purchase a new smartphone with an amplifier and let the audiologist teach you how to use it.
- Make sure hearing aids have a means that allow for hearing aid use (e.g., telecoil or streaming).
- Use a speaker phone.
Problem #2: The television is very loud and that really annoys my wife.
Goal: Watch at least one television program together per night with the volume turned down and the person with hearing loss able to understand the conversation.
Tactics to Achieve Goal:
- Use an assistive listening device for the TV.
- Rely on closed captioning.
- Use the streaming capability of hearing aids.
Problem #3: We avoid going to restaurants with other couples because my husband cannot hear them, and I get frustrated when that happens.
Goal: Go with another couple or friend to a restaurant that everyone mutually agrees upon during a popular time of day.
Tactics to Achieve Goal:
- Identify the quietest part of the restaurant to have a conversation.
- Use a remote captioning app (e.g., Ava or HiThere!) on the smartphone to supplement verbal communication.
- Share with your friends that you have trouble hearing and you need to sit in the quietest part of the restaurant.
- Use remote microphone technology of hearing aids with help of audiologist.
- Be aware that it won’t be perfectly clear and I will need to listen carefully. I may miss a few words and it’s okay to ask others to repeat or restate sometimes.
- Use SoundPrint, a smartphone app, to identify restaurants with acceptable noise levels.
Problem #4: Both of us get frustrated and agitated when I cannot hear during conversations during meals at home between the two of us.
Goal: Carry on a conversation with each other during dinner in which both people can participate in a relaxed manner.
Tactics to Achieve Goal:
- Make sure you’re wearing hearing aids and they are properly adjusted.
- Minimize all distractions such as background noise and smartphones.
- Ensure the room is well light and the acoustics are reasonable.
- Don’t be in a rush.
- Be aware of the noise levels in busy social situations.
- Consider the use of a smartphone-based sound level meter to monitor noise levels.
- Acknowledge that you won’t hear every word and it’s ok to have some things repeated.
- When your wife has to repeat something, it helps to rephrase it.
Let’s now turn our attention to some specific tactics that can be used with persons with hearing loss and their CP to establish clear and actionable goals. The objective of this section is to provide audiologists with practical skills and insights to help them better manage the appointment process in which communication goals are set. The next section reviews several critical areas in which an audiologist interacts with a person with hearing loss and their CP. For each of the components below, specific tactics that the audiologist can use to create deeper level of engagement between the person with hearing loss and CP.
The Appointment as an Information Gathering Process
Before going any further, it’s important to appreciate the interaction between the audiologist, the person with hearing loss, and the CP as an opportunity to gather information. Too often, audiologists get ahead of themselves and focus on ends, rather than the means. That is, by virtue of their strong desire to help persons with hearing loss achieve improved hearing, it is natural for audiologists to focus all of their energy on specific recommendations to be generated at the end of the appointment. When audiologists focus on the end results, it is easy to rush through or gloss over critical points during the appointment when the person with hearing loss can “tell their story.” One way to overcome a rush to the finish, is to view the hour-long appointment as an opportunity to gather as much information as possible about the help seeker’s predicament with as much input as possible from the person with hearing loss and the CP.
Even though an audiologist may have seen thousands of help seekers over their career, it always helps to get into the correct frame of mind prior seeing the next help seeker for a consultation. Putting yourself in the shoes of the person with hearing loss enables the audiologist to capture opportunities where a stronger relationship, built on trust and mutual respect, can be fostered. Imagining from the person with hearing loss and CP’s vantage point what they may have been coping with over the past several years, being curious about their predicament and viewing the appointment as a factfinding mission is a helpful approach to patient engagement.
The First Interview
The first interview with a help seeking individual and a CP is a little like meeting strangers at a social gathering for the first time. All parties – the audiologist, the person with hearing loss and the family member– know a little something about the other, but not enough to feel comfortable with one another. A primary task of the audiologist during this uncertain opening moment of an appointment is to help everyone in the room feel comfortable enough with each other to continue the relationship. It helps to include the family member/ CP in this first interview, as they bring a unique perspective.
According to Perry (2008) the key to creating a trusting relationship between the audiologist and the help seeker (and their CP) rests with the audiologist’s ability to communicate with genuine warmth and hospitality. The ability to communicate in this manner is determined largely by cultural norms. For example, there are differences in how you greet a help seeker in the deep South compared to the upper Midwest. In the South, cultural norms warrant a stranger is greeted like a long-lost friend, while that same avuncular greeting in the upper Midwest is likely to be perceived by the help seeker as cloying and insincere. Observing these unspoken cultural norms of your community helps put help seeking individuals and their CP at ease by introducing the familiar into what is usually an uncomfortable and anxietyridden situation for the help seeker and the CP.
A Word about Terms
In the patient centered model of care, the terms “persons with hearing loss” and “help seeking individual” or simply “help seeker” replace the term “patient.” This tutorial uses those terms interchangeably to describe what many still refer to as patients, a term that implies the individual is passive and dependent on others in making decisions about their own care.
At the same time, it is imperative for the audiologist to maintain an aura of professionalism. After all, the help seeker and their CP will be relying on the audiologist to guide them through the process of understanding the help seeker’s condition and treatment options. It is the audiologist, not the help seeker, nor his CP, who is an expert on diagnosis and treatment. On the other hand, it is the person with hearing loss and CP who has been coping with the consequences of a “problem” for a period of time. To be effective, the audiologist must keep a certain amount of emotional distance. This duality – being warm and hospitable, while maintaining an appropriate professional distance may be one of the most difficult challenges faced by audiologists.
Many audiologists find their comfort zone to be confined to conducting a hearing assessment and describing the results to the person with hearing loss. A helpful approach, however, that helps audiologists get beyond their comfort zone, is to talk about the underlying emotions associated with adultonset hearing loss. Research shows that untreated hearing loss is linked to social isolation, loneliness, and reduced quality of life. See Shukla, et al (2020) for an evidence-based review of these conditions. Some of the emotions associated with social isolation and loneliness include anxiety, fear, agitation, and withdrawal. Because CPs have a strong attachment to their loved one coping with hearing loss, they in- turn manifest some of the same strong emotions. It is helpful to think about this relationship between emotions and conditions associated with hearing loss from the person with hearing loss and their CP’s point of view. Most persons with hearing loss and CPs are struggling day-to-day with the consequences of hearing loss. Oftentimes they are not well versed in the underlying conditions causing the emotional strife. For this reason alone, it is vital for the audiologist to focus on the emotional struggles associated with the hearing loss, and to be willing to acknowledge and talk about the underlying emotions associated with hearing loss for both parties.
It can be easy to focus on conducting the test and explaining the results, while overlooking the tension that may be building up in the room. When the underlying emotions associated with hearing loss (and perhaps learning for the first time there is a quantifiable problem) are not acknowledged, the audiologist has lost an opportunity to engage the person with hearing loss and their CP. By earnestly acknowledging and addressing these underlying emotions, audiologists can provide a deeper level of engagement. It is this deeper level of engagement that enables persons with hearing loss and the CP to better adhere to the recommendations that come at the end of the consultation.
The process of acknowledging the emotions in the room starts with the audiologist’s ability to have the language (commonly referred to as a ‘talk track’) to address situations in which tensions are perceived to be rising in the room during an appointment. As a general rule, when acknowledging emotions, audiologists need to use “I” statements. Here are some “I” statements audiologists can use with persons with hearing loss and their CPs to acknowledge the emotions in the room.
- “I sense you feel anxious about that situation you just described. It’s ok to feel that way. Let’s talk about it some more.”
- “I noticed that you nodded your head in disagreement to what he just said. What do you think is happening?”
- “I feel like there is a lot of disagreement between the two of you on his ability to communicate at home with the family. Let’s have both of you explain what you are noticing."
Asking Open Ended Questions
When a person with hearing loss and their CP are interacting with the audiologist during the initial consultation, it is an opportune time to discuss the reasons why they decided to go through the hearing evaluation process. After all, many adults with hearing loss wait several years before seeking help. Thus, it is helpful to explore the salient events that prompt their appearance in the clinic for a consultation. Discovering the salient event – an occurrence of significant importance – is a chief reason for asking open ended questions of both the person with hearing loss and their CP, as it allows both parties to tell their story of what brought them into the clinic today, rather than two or three years ago.
Simply asking the person with hearing loss and their CP to tell you why they are now in the clinic seeking help is an effective approach to uncovering the salient events that prompted action. Because salient events are emotional by nature, it is likely asking about them will prompt some of the emotion discussed previously. Here is a sequence of openended questions pertaining to discussion of salient events. Note how some of the questions are directed at both the person with hearing loss and their CP.
- What brings you into the office today?
- What brings you into the office today along with Mr. Smith (the person with hearing loss)?
- What is it about that situation that prompted you to schedule an appointment?
- How many years would you say that your ability to hear has been an issue with your wife?
- What kind of activities do you do together?
- How much of a struggle are those activities for each of you?
How Goal Setting is Done in My Practice
In our practice, goal setting is a critical factor in the fact finding and evaluation of communication challenges experienced by both the person with hearing loss and their CP. It all starts with understanding the real-world perspective of both parties. There are at least a few ways in which we go about assessing communication needs and it all starts with the initial interview.
Interviewing the person with hearing loss, and if possible, their CP, is the most effective way for them to talk about what restricts communication and why breakdowns occur. This directs and encourages exploration of possible reasons for challenges in communication and allows them to make statements about their own subjective impression of possible challenges in a variety of settings. We pay close attention to asking open-ended solicitations like, “Tell me about the challenges you face in hearing.” The answers from the persons with hearing loss and their CP will highlight their respective concerns and their own views on problems and situations at hand. This will also give the audiologist a better sense of the degree to which informal conversations are successful for all respective parties. This is a great way to illicit person-specific information. For example, we may find that the person with hearing loss is engaged in lots of meetings at work and that this is something of utmost importance to them.
It is important to be mindful that answers from an interview do not always render themselves well to measurement, and thus may pose a problem when there is a shift in communication behavior because of treatment and rehabilitation, which needs to be documented. Generally, the audiologist should do more listening and less talking during an interview. Keeping close eye contact and listening with genuine interest is key. Asking a person to elaborate on their answer rather than moving on to the next question is a great way to understand communication difficulties with which the interviewee is struggling. Acknowledging the person’s bravery to come to the clinic to positively change the quality of their own life, and listening to the person with hearing loss without judgement lets them know that we support them.
Another quick and easy way we use to assess communication needs and fluency in conversation is validated questionnaires. They are an excellent tool , designed to collect general information about how often breakdowns of communication occur, and how both the person with hearing loss and their CP attempt to restore those breakdowns. There are a few well-known, short, questionnaires, popular among clinical audiologists, that aim to understand subjective communication challenges faced by both parties. Currently, we use the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) as well as a companion questionnaire to find out more about communication barriers and their subjective effect on the person with hearing loss and their CP. The HHIE-S evaluates an older individual’s perceptions of emotional and social effects of hearing loss. It is a short 10-item questionnaire with two subscales for emotional consequences, as well as social and situational effects (Ventry, 1983). The higher the HHIE-S score, the greater the handicapping effect of a hearing impairment. Scores may range from 0 (no handicap) to 40 (maximum handicap). Specifically, the purpose of the HHIE is to pinpoint communication problems, as perceived by the person with hearing loss. Each question is to be answered with YES, SOMETIMES, or NO and it is to be answered according to the way they are hearing without any hearing instruments. The HHIE-S provides a great starting point to the dialogue with the person with hearing loss, without having to have them complete a lengthy or confusing questionnaire. The HHIE-S is also available in many languages. It is an effective tool in assessing the effects of hearing loss on everyday communication, and an effective tool for identifying individuals who are most likely to accept our treatment recommendation. We have found the higher the score on the HHIE-S, the more likely it is for that person to accept our recommendation for hearing aids. Importantly, the HHIE-S is a self-reported inventory and thus appropriate for individuals without cognitive deficits who can verbally or in a written form respond to the questions.
For the CP, we counsel and give tutorials on communication strategies that help them more effectively communicate with the person with hearing loss. Behaviors such as keeping their face visible to the person with hearing loss will allow them to see and use all the visual cues available to them. Additionally, strategies like keeping a slight pause between the content sections of sentences will allow the person with hearing loss to process the speech in chunks. Oftentimes, simulating the hearing loss for CPs (using loudspeakers in the exam room) helps them appreciate the challenges of hearing loss.
Finally, we ask the CPs to try to get the listeners’ attention before starting a conversation and to control their listening environment (for all parties involved) by moving closer to the person with hearing loss. We also remind them to avoid poorly lit environments and places with higher levels of background noise. Finally, having a plan and anticipating adverse listening environments such as having CPs communicate with the staff in a loud restaurant instead of the person with hearing loss will afford more ease in communicating and less frustration trying to understand speech in such acoustically demanding spaces. Effective communication strategies such as the abovementioned tools, techniques, and goals can enhance and accelerate the hearing aid acclimatization process for both parties.
A by-product of facilitating a conversation, using openended questions, is that some individuals may feel the need to blame the other party for their own personal failure. For example, a CP, when asked to discuss her frustrations with her husband’s (person with hearing loss) inability to turn down the TV or willfully ignore people, may express real feelings of resentment and frustration toward their partner. The person feeling frustrated or resentful might even take an accusatory stance toward the other person and begin to blame them for a deteriorating relationship. When the tension in the room begins to become too great and one party begins to blame the other, it is essential for the audiologist to reframe the conversation.
Reframing is the audiologist’s ability to intervene and guide the dialogue toward more positive ground. In a situation in which one party begins to blame the other for their shortcomings, the audiologist can intervene by asking the person with hearing loss and their CP to explore solutions to the problem, rather than find blame. In other words, the audiologist asks both parties to look for solutions to improving communication-related quality of life issues rather than dissecting the problems as a personal failure on the part of either the person with hearing loss or their CP. Here are some reframing statements that help move the dialogue toward a solution.
- “I understand how frustrated you are. Let’s look at the future and how we can improve the situation.”
- “Now that each of you has had a chance to tell your side of the story, let’s find some ways we can work together to make it better.”
- “Let’s brainstorm some possible solutions to this problem so you feel better prepared to handle it when it happens again.”
- “No one is perfect. I am sure we can all agree on that, but now I want us to explore how each of you are impacted by his hearing loss and how we can improve family life at home. “
- Let’s work together to find ways to solve this problem so it is less likely to happen in the future.”
Opportunities to Involve Both Parties
In addition to getting the person with hearing loss and their CP involved during the initial consultation there are other times that provide opportunity for engagement. Here are some opportunities to deepen the level of engagement between the person with hearing loss and their CP after the first appointment.
It seems to be a common practice for audiologists to call a person with hearing loss 24-to-48 hours after a hearing aid fitting appointment. The purpose of the call is to check in with them and monitor for any problems that may preclude the person with hearing loss from using their hearing aids until the next scheduled appointment with the audiologist. This scheduled phone call is also an opportunity to ask the person with hearing loss if they have any questions about expectations or initial hearing aid use.
A wrinkle that can be added to this approach is to include the CP on the follow-up call. By including both parties, the audiologist gets instantaneous feedback from the person who typically spends the most time with the person with hearing loss. Involving the CP can be easily accomplished by using video conferencing technology, such as Apple Facetime or Skype. Unlike an audio-only phone call, video conferencing allows for both parties to participate more actively in the dialogue with the audiologist in a way that better simulates the face-to-face appointment. The audiologist can set the stage for the follow-up call by scheduling this video conference at the end of the fitting appointment. During the video conferencing appointment, the audiologist aims questions at both parties, and much like the face-to-face appointments, encourages both to “tell their side of the story.”
Coaching on Technical Matters
Initial hearing aid use can be overwhelming for many persons with hearing loss. Not only is the process of acclimating to new sounds challenging but there is a considerable amount of technical information to absorb. Everything from Bluetooth streaming to remote fine-tuning and smartphonebased apps add additional complexity to the learning process. Given the abundance of information to learn, it is easy for some persons with hearing loss to become overwhelmed and give up on using their devices. Including the CP in the further acquisition of technical knowledge about hearing aid use, affords the person with hearing loss another individual they can rely on if they have a question. In addition to teaching the CP about the technical details of how to clean hearing aids, change the batteries, etc., the CP can be taught how to answer periodic technical questions that might arise by first seeking information on-line.
Four Key Areas of Dialogue
There are four areas of importance which present challenges for the CP: 1.) The broad-ranging effects of hearing loss on the CP’s everyday life, 2.) The CP’s need to constantly adapt to their partner’s hearing loss, 3.) The effect of acceptance of the hearing loss on the CP, and 4.) The impact of the hearing loss on aging and retirement. Given that these areas have an impact on the CP as well as the person with hearing loss, many of the tactics outlined in this tutorial will help improve overall engagement in the process of remediating the consequences of hearing loss. Let’s take a look at each of these four areas in greater detail.
The most successful audiologists intuitively know that their ability to ask open-ended questions in an authentic manner is a cornerstone of their effectiveness. By involving both the person with hearing loss and their CP in the process of discussing these four areas, the audiologist will likely foster a deeper level of engagement with both parties.
1. The Broad-Ranging Effects of Hearing Loss on the CP’s Everyday Life
Pose questions to the help seeking individual that allows him to elaborate on the impact of his hearing loss on the CP’s day-to-day existence. For example, the audiologist may ask, “Take me through a typical day. Tell me about how you think your hearing loss might affect your spouse?”
2. The CP’s Need to Constantly Adapt to Their Partner’s Hearing Loss
A second line of questions can be directed to the CP. By asking the CP to discuss how they have adapted or modified their daily routine to accommodate the help seeker’s hearing loss, the audiologist may help the person with hearing loss better understand the impact of hearing loss on the CP.
3. The Effect of Acceptance of the Hearing Loss on the CP
The audiologist can begin to paint the picture of what successful remediation of hearing loss looks like by asking the CP what day-to-day living would be like if the person with hearing loss were to have improved hearing. When the audiologist asks the CP to discuss what the future might look like if the help seeker had better hearing and communication ability, the process of acceptance is more likely to begin.
An example of a line of questioning around this issue might be for the audiologist to ask the CP, “What would it be like if [Name] was able to carry on a conversation at your favorite restaurants with much less difficulty, or if you could watch TV together and hear almost every word when the volume is at a comfortable level for you…..how would you feel if we could help [Name] hear better in this important situation?”
4. The Impact of the Hearing Loss on Aging and Retirement
A final line of questioning is also related to the audiologist’s ability to help the person with hearing loss and their CP paint the picture of a future in which hearing loss does not cause emotional strain. By querying both parties about a future that does not involve having to cope with untreated hearing loss, a deeper level of engagement can be obtained. By asking both parties to talk about a life in which the struggles associated with hearing loss are overcome, the audiologist is able to help them focus on taking active measures to improve communication in places they deem important.
The initial consultation with the person with hearing loss and their CP is a golden opportunity to begin the goal sharing process. The ability of the audiologist to include both parties in the process of goal setting is predicated on the audiologist’s ability to ask thoughtful open-ended questions to the patient and their CP. Through curiosity and authenticity, the audiologist can create a dialogue with both parties that builds trust and culminates in more successful outcomes. Applying the four principles of Goal-sharing for Partners Strategy (GPS) along with several of the other patient centered strategies, outlined in this article, goes a long way toward activating persons with hearing loss and their CP on their shared journey towards acceptance of their condition. ■
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- Kamil RJ, Lin FR. The effects of hearing impairment in older adults on CPs: a systematic review. J Am Acad Audiol. 2015;26(2):155-182.
- Kochkin S. MarkeTrak VIII: The key influencing factors in hearing aid purchase intent. Hearing Review 2012;19(3):12-25
- Merner B, Schonfeld L, Virgona A, et al. Consumers’ and health audiologists’ views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev. 2023;3(3).
- Perry, Wayne. Basic Counseling Techniques: A Beginning Therapist’s Toolkit. 2008; AuthorHouse Press
- Shukla A, Harper M, Pedersen E, et al. Hearing Loss, Loneliness, and Social Isolation: A Systematic Review. Otolaryngol Head Neck Surg. 2020;162(5):622-633.
- Ventry, I.M., & Weinstein, B.E. (1983). Identification of elderly people with hearing problems. ASHA, 25, 37-42.
Navid Taghvaei, Au.D., is a private practice owner and senior clinical specialist for Signia. He can be contacted at