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Geriatric Patient-Centered Care: Hearing Status Plays Integral Part

Weinstein, Barbara E. PhD

doi: 10.1097/01.HJ.0000465737.18097.d0
Golden Rules

Dr. Weinstein is professor of audiology and founding executive officer of Health Sciences Doctoral Programs at the Graduate Center, City University of New York, and coauthor of the Hearing Handicap Inventory for Adults and the Elderly.



Clinical management of elderly patients is complicated by the challenges of multimorbidity, with 50 percent of older adults having three or more chronic conditions.1 A guiding principle of patient-centered care in this population is the incorporation of patient preferences crucial for medical decision making.1



This principle is based on the concept of shared decision making, which is defined by its interactive nature, with collaborative participation throughout every step of the process.2,3 Such a cooperative effort between patients and clinicians adds to the value and quality of healthcare.4

Three domains of behavior are characteristic of shared decision making: eliciting the patient's feelings and beliefs, ensuring that the patient is adequately informed about the diagnosis and the expected benefits and harms of treatment options, and analyzing the decision and reaching closure once the outcomes of treatment options are understood.5 The table on page 18 lists the steps involved in achieving patient-centered care.

Patient-centered care helps improve patient satisfaction, information recall, adherence, and quality of care. Reductions in healthcare costs and decreased disparities are important by-products of this approach.6,7

Good physician–patient communication is integral to achieving shared decision making and a positive patient experience.8 People with hearing loss have lower ratings of physician–-patient communication and overall healthcare than people with normal hearing do.9 In fact, primary care physicians with malpractice claims filed against them exhibited poor communication and a lack of empathy relative to primary care physicians without malpractice claims.10

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The optimization of patient-centered care requires interprofessional collaboration among healthcare practitioners. Ideally, cooperation should occur across all disciplines, with respect shown for the skills and knowledge of a particular healthcare professional.11

However, differences in the understanding of professional scopes of practice, roles, and responsibilities across disciplines pose a significant barrier to the achievement of true interprofessional collaboration and value-driven patient-centered care.11

Another barrier is a failure to recognize that the ability to communicate—that is, to make oneself understood and understand others—is a cornerstone of high-quality patient-centered care. Most healthcare professionals do not acknowledge hearing loss as an invisible handicap that interferes with communication, posing a barrier to informed healthcare decision making.

Audiologists must be part of interprofessional teams working together to foster adoption of effective ways for patients and providers to improve the shared decision-making process. A starting point for audiologists could be to develop health education content describing how hearing loss can contribute to low patient engagement and passivity during medical encounters. A second role could be offering tactics to engage patients with hearing loss.

The focus should be on developing materials that emphasize how audiologists can add value and assist in improving outcomes by helping optimize hearing status. Additionally, we must discuss with our patients their role in the care process and the actions they must take to elevate their experience when engaging in shared decision making.

From this perspective, one of the key factors both stakeholders must accept is that establishing clear communication and making sure the patient understands what the healthcare provider is communicating is a shared responsibility.

The use of decision aids could be especially effective with patients who have hearing loss, as supplementing the auditory modality with visual input may help reduce the proportion of patients who are passively involved in decision making and draw out patient preferences so critical to determining a chosen intervention.

Audiologists are the professionals with the expertise to promote the communication skills of the patient and provider. We must develop training tools that will enhance physician–patient communication, leading to positive outcomes from patient-centered care.

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Delivering Patient-Centered Care: Follow These Factors6,12,13

  • Focus on the patient. Understand and meet the patient's needs and preferences.
  • Inform and educate patients and their families about treatment options and the course of care.
  • Frame and tailor information according to your understanding of the patient's concerns, beliefs, and expectations.
  • Be aware of the patient's level of health literacy and hearing status.
  • Recognize that patients often become overwhelmed by the volume of information shared.
  • Emphasize the quality of relationships and interactions between patients and clinicians. Patients must be guided toward greater involvement even when they express a desire to be passive.
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1. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society. J Am Geriatr Soc 2012;60(10): 1957-1968
2. Charles C, Gafni A, Whelan T. Shared decision making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5):681-692
3. Charles C, Gafni A, Whelan T. Decision making in the physician—patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999;49(5):651-661
4. Kerr EA, Hayward RA. Patient-centered performance management: enhancing value for patients and healthcare systems. JAMA 2013;310(2):137-138
5. Saba GW, Wong ST, Schillinger D, et al. Shared decision making and the experience of partnership in primary care. Ann Fam Med 2006;4(1):54-62
6. Epstein RM, Fiscella K, Lesser CS, Strange KC. Why the nation needs a policy push on patient-centered healthcare. Health Aff 010;29(8):1489-1495
7. Haskard Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009;47(8):826-834
8. Browne K, Roseman D, Shaller D, Edgman-Levitan S. Analysis & commentary. Measuring patient experience as a strategy for improving primary care. Health Aff 2010;29(5):921-925
9. Mick P, Foley DM, Lin FR. Hearing loss is associated with poorer ratings of patient—physician communication and healthcare quality. J Am Geriatr Soc 2014;62(11):2207-2209
10. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician—patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277(7):553-559
11. D’Amour D, Oandasan I. Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept. J Interprof Care 2005;19(suppl 1):8-20
12. Poost-Foroosh L, Jennings MB, Cheesman MF. Comparisons of client and clinician views of the importance of factors in client—clinician interaction in hearing aid purchase decisions. J Am Acad Audiol 2015;26(3):247-259.
13. Grenness C, Hickson L, Laplante-Lévesque A, Davidson B. Patient-centered care: a review for rehabilitative audiologists. Int J Audiol 2014;53(suppl 1):S60-S67
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