Editor's Message: Moving from Product Centered to Patient Centric Requires More than Lip Service

Author: Brian Taylor, Au.D.

One of today’s great ironies is that, as amplification technology becomes more automated, the aging adult’s desire to have a trusting and supportive relationship with their audiologist is stronger than ever. This statement is underscored by many recent findings from leading researchers, including Gaby Saunders, Arlene Carson, Louise Hickson, Caitlin Grenness and Arianne Laplante-Levesque. They are among a leading group of audiolgists who have been studying the use of various chronic disease state models to describe the behaviors and attitudes associated with age-related hearing loss, the third most common chronic condition in older Americans. One model, often mentioned in their research, is the “Stages of Change” theory shown in Figure 1.
Figure 1. The Stages of Change Model which Describes Help Seeking Behavior of Adults with Age-related Hearing Loss.

It is easy to forget, especially when many audiologists are incentivized to dispense hearing aids in a bundled pricing structure, that adults with gradually declining hearing loss move through a series of milestones before finally taking action to address the daily challenges associated with their hearing difficultues. These milestones, which include an array of help-seeking behaviors, are labeled below in Figure 1. With each stage there are a litany of behaviors and attitudes associated with it. According to “Stages of Change” experts, the role of the audiologist is to recognize these behaviors and guide the patient onto the next stage of change. This requires a far different set of skills than trying to convince a patient they need to wear hearing aids. Also, notice how there are two additional stages following the action stage. This reminds us that our ability to help patients cope with chronic conditions, like hearing loss, doesn’t end after the culmination of a successful hearing aid fitting. Chronic conditions, like age-related hearing loss, require vigilent management over time.

Given the impending re-regulation of hearing aids, including the creation of a new direct-to-consumer product category, audiologists must identify innovative ways to create value for consumers. One way to accomplish this is to infuse the Stages of Change model and its associated solution-based interviewing strategy into our clinical routine. Rather than trying to sell a set of hearing aids to each patient who has hearing loss, audiologists must establish goals for patients that provide a shared sense of understanding of the travails associated with their long-standing condition. Shared understanding starts with our ability to:
  1. Help patients regain their sense of control of daily communication.
  2. Tip the cost/benefit ratio so that patients are willing to take action on a recommended treatment option.
  3. Promote help-seeking behavior by moving “hearing help” to the top of the patient’s list of priorities.
Guiding patients through the Stages of Change, by allowing the individual with the hearing difficulties to set the agenda during their consultation with the audiologist, is a good start to breaking our product-centric focus. Further, by creating an atmosphere that centers on the importance, commitment and confidence needed by patients to change many of their handicapping and debilitating behaviors associated with age-related hearing loss, audiologists can break an over-reliance on recommending hearing aids for every patient with hearing difficulties. By embracing the Stage of Change model, real patient-centered communication, and solution-focused interviewing, we can provide a deeper level of service that is not bound to a product. Audiology needs to be defined, not by the devices it dispenses, but by what consumers with hearing difficulties desire.