As part of her PhD studies at the University of Melbourne, Caitlin Grenness is conducting research on patient-centered care and clinical communication, exploring the interaction between audiologists and older adults with hearing loss during consultation sessions. The research is funded by the HEARing Cooperative Research Center in Australia. It falls under a larger project led by Louise Hickson to explore the factors that facilitate or inhibit adult with hearing impairment from taking action and achieving good outcomes.
The first part of Caitlin’s research explored how patients define patient-centered care. Caitlin collaborated with Louise Hickson and Ariane Laplante-Levesque to conduct an interview-based study asking adults how they defined patient-centered hearing care.
Caitlin shared with us some of the study’s preliminary findings, as the complete results are expected to be published sometime this year.
“Through the interviews, we found that patients very much value the communication skills of their audiologist and the concept of the therapeutic relationship, where a level of trust is developed between the audiologist and the patient,” states Caitlin. “There were other things, however, that patients were uncomfortable with. In Australia, where the interviews took place, they were uncomfortable with some of the commercial aspects of hearing rehabilitation and hearing aid sales. This finding emphasized the importance for audiologists to take the time to develop the therapeutic relationship with the patient and to let them know that they can trust you and that you are recommending a certain strategy based on their unique interests.”
If the first part of Caitlin’s research explored what adults want from patient-centered care, the second part explores whether they end up getting what they want. Caitlin worked with Carly Meyer, who currently holds a HEARing CRC Postdoctoral Fellowship, to film 60 consultation sessions with 26 different hearing care professionals across Australia. They watched the collected footage and applied the Roter interaction analysis system (RIAS) to analyze the interactions between the audiologist, the patient, and their communication partner, if present.
RIAS is one of the most commonly used systems for analyzing communication between clinicians and patients. It consists of a detailed classification system where each verbal utterance in the consultation session is coded and assigned to a particular category. The RIAS method has been used to analyze patient interactions in other medical fields, but this is the first time that it has been applied to the field of audiology.
“All of the details will be published shortly, but we are finding that there is room for improvement in how patient-centered the audiologist’s communication is when interacting with the patient. A lot of the things we are seeing would be very easy to change. These things include when to use an open-ended question, focusing more on listening skills, and reviewing how much the audiologist controls the overall direction of the consultation session,” states Caitlin Grenness. “The videos can show clinics that despite the fact that we think we are practicing in a patient-centered way, we often do not fit that mold. In the future, we hope to look into developing educational programs to help clinicians take these easy steps to improve their communication and their interactions with patients.”
As Caitlin Grenness and Carlie Meyer continue to analyze the video footage, they find that their research opens up a number of other questions that could lead to future research studies. One of them is to determine the effect of patient-centered communication on long-term patient outcomes. This research data would be very valuable to large government health organizations, as this data could show that small changes in communication style could improve overall outcomes in hearing-impaired adults. Another question concerns the presence of communication partners in the consultation session and how it affects patient-centered communication and the interactions between the audiologist and the patient. Lastly, the collected footage has been shared with a number of psychologists to further explore the effect of nonverbal behaviors between clinicians and the patients.
Caitlin Grenness, along with her colleagues from the HEARing CRC research team, will present all of the research results in May 2014 at the World Congress of Audiology in Brisbane, Australia. In addition to being a PhD candidate at the University of Melbourne and a Research Assistant at the HEARing CRC, Caitlin Grenness is a Clinical Tutor in the Department of Audiology and Speech Pathology at the University of Melbourne. Caitlin attended the Ida Institute seminar series on Managing Change in 2012.