New Thoughts on Hearing Loss and Stigma

Hearing Excellence Low Resolution-9533Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.) of Hearing Excellence

Christchurch, New Zealand

Two models of disability, the medical model and the social model, currently represent the opposing ends of the continuum of what defines disability (Berger & Lorenz, 2015).

The medical model sees disability as an individual’s bodily event and so concentrates on aetiology, diagnosis, prevention, and the treatment of the physical, sensory and/or cognitive impairments. Past scholars of disability often took this negative deviance medical approach; bioethicists and eugenicists have spent most of their energy on justifying the morality of preventing or even eliminating people with disabilities by the use of prenatal testing and abortion, or by withdrawal of care (Parens, 2001).

The social model of disability, at the other end of the spectrum, moves away from the impairment itself to consider the socially imposed barriers for the disabled, such as inaccessibility and unequal rights. It also considers the prejudicial attitude (i.e., stigma) that is constructed around any disability and results in sub-ordinate social status and a devalued life (Berger & Lorenz, 2015; Bickenbach et al., 2014). The social model evolved from the disability rights movements in the UK and USA in the 1960’s and 70’s, and carries the notion that a society should embrace all members and address socially imposed barriers.

Regardless of which model is used, stigma seems to be a universally understood experience. Stigma occurs as a process by which people stereotype, label, judge, and then discriminate against others who are different (While & Clark, 2010) and so they spoil any sense of normal identity for the other person.

Goffman (1963) outlined three causes of social stigma:

  • overt, external deformations;
  • personal trait deviations such as mental disorder or addiction;
  • tribal/cultural deviations from a norm in terms of physical appearance like skin colour, dress style, religion, or behaviour.

Goffman added that stigma is the phenomenon whereby an individual with an attribute is deeply discredited by their society and therefore rejected as a result of the attribute.

Understanding Our Reactions

We are drawn to the unanticipated and the inexplicable in an effort to make sense of the experience, a universal part of our cognitive architecture that natural selection has bequeathed us (Garland-Thomson, 2006). We also experience aversion to others who do not fit into Goffman’s (1971) concept of normalcy. This aversion is a primitive response, demonstrated at the minimum with glancing or staring as a sifting mechanism to define safe or “otherness” status among those around us. For example:

I used to travel with a fellow Board member who had one of the first cochlear implants in New Zealand, which is very obvious as he has no hair to hide it. Walking through airports with him was fascinating as I watched others observe, try to decide what it was, understand/comment to their fellows about it and then finally return to their own activities. Before it could be socialised out of them, children had no concern about direct enquiry of David – “What’s that thing on your head, mister?” Being stared at by an adult can mean a lack of understanding, or at worst a social disregard, but children have the “curiosity excuse,” and he loved to take the pieces off his head and explain them to the fascinated child, while the parent often squirmed in embarrassment.

Although on the surface innocuous, staring is actually a strong reaction towards another person and excites the brainstem’s primitive level neural activity (Garland-Thomson, 2006), which is part of our fight or flight system. Stigmatic judgements are made with such fast glances and decisions. The inclination to stigmatize others has long been documented; for instance, in Roman times thieves and slaves were visibly tattoed to identify them as non-equal human beings.

Stigmatising another person can not only make the stigmatised person suffer negative consequences but can, conversely and perversely, enhance positive feelings of membership of the stigmatising tribe by the rise in self-esteem and sense of power that “doing others down” can bring (Falk, 2001). This tribal group-think against the stigmatised person has been used to justify terrible attacks seen worldwide, in which a stigmatised person – often intellectually disabled —  holds little value and so can be beaten or killed as they are considered sub-human.

31970396_sThe Impact of Labels

 When a label or stigma is applied to a person/group, there is a surrounding negativity or taint which engenders feelings of lesser worth in those subjected to the labelling. Being the subject of stigma can adversely affect the behaviour of the stigmatised by changing their emotions and beliefs (Major, 2005). The stigmatised person can become isolated, and then depression and lack of self-esteem can follow (George, 2015). Internalised stigma also leads to decreased hope and self-efficacy, and a poorer general quality of life (Nabors et al., 2014). This impact is not unique to hearing loss – just think about our seniors who have age labels, hearing loss, vision loss, cognition loss and physical disability labels to carry. Continue reading

Audiologist-Centred Patients Are the Outcome Goal of Patient-Centred Audiologists

Jeanine photo 2015

Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.) of Hearing Excellence

Christchurch, New Zealand

Loyalty of patients to their Audiologists is a “win” for all parties. In a business sense, loyalty means repeat business and word of mouth referrals from current patients and both of these are less expensive than attracting new business (Morgan & Hunt, 1994). Thus, a relationship-based strategy builds a firm’s competitive advantage (Morgan & Hunt, 1994; Sumaedi et al, 2015) and patient- centered care can clearly fit this bill.

As a clinician, my experience is that it is the long-term relationship with repeat patient visits that helps make my career so rewarding and keeps me engaged; and for the patient the trust relationship they develop over time with their audiologist must make their interactions much more rewarding emotionally.

Audiology can learn from the general business, especially the service sector, literature and from this customer loyalty has been found to have two main components (Cater & Cater, 2009):

  • Affective (emotional) commitment, which develops from trust and social bonds (liking each other and learning about each other and so includes listening to patients), with trust the more important by far. Health is a “credence category service” and trust is very important in such a context (Chang et al, 2013). Humans also have an additional resistance to change which acts as a loyalty antecedent (Silva, 2015).
  • Relational (rational) benefits such as access, marketing and pricing can lead to perceived satisfaction, but satisfaction ranks second to emotional commitment in establishing loyalty.

hearthead

This Cater and Cater (2009) dual-factor model of motivations of general service industry loyalty includes all the factors in the audiology specific model developed by Grenness et al (2014). The themes from their patients’ data show that they seek individualised care, clinical procedures including information sharing and shared decision making, and the recognition of the importance of the players who make up the therapeutic relationship (i.e., audiologist and patient). These themes would fall into Cater & Cater’s 1st emotional commitment category and show the importance of meeting the emotional need of patients to allow a successful and loyal patient/audiologist relationship. Continue reading

Reflections on Response to Change

CarolyneCarolyn Edwards, M.Cl.Sc., M.B.A.

Auditory Management Services

Toronto, Ontario Canada

Most of us as human beings do not invite change into our lives as a natural part of each day. The reality is that we fall into pattern and that pattern is comfort and security. We do anticipate some natural progression in our work or personal life but when unexpected events change the course of our lives, most of us resist that change at the outset.   The way we resist change takes many forms.   We can stay in denial or surprise, we can blame others or we can fight against the change. Specifically resistance may come in the form of delaying – give me more detail, flooding others with the details, intellectualizing, moralizing, OR impulsive action – everything is suddenly fine, I need a solution fast, blaming others without warning OR sustained confusion or denying the impact (I’m not surprised).   Over time, if we accept the changes that have occurred, we can find a flow, and change becomes an ally rather than the enemy we originally perceived.

Resistance is the outward expression of fear – I am afraid – of being vulnerable, of having to change, of losing control, of not knowing what to do, of being different and being rejected because of the difference. Each of us has our own fears based on our life experiences, and yet the underlying fear of the unknown is understood by all of us.

Listening to our clients’ responses is essential to determine where they are in the process of change, because the reality is the diagnosis of hearing loss brings change.

Addressing Resistance5276781_s

When we are resisting change, we cannot hear others and often we cannot hear themselves either. We may be aware or unaware of our resistance; we can feel the fear and don’t know what it is.   Resistance becomes the only way we know how to communicate at the moment. As professionals, when you are observing resistance in your clients, it is often more effective to address the actual behavior at the outset than the fear itself. For example, the behavior may be the inability to attend the scheduled appointments, the lack of questions, a parent’s inability to follow through with agreements to work with their child, a child’s rejection of support, the desire to talk about the same concerns repeatedly, the disinterest in follow-up appointments, or an adult’s consistent use of amplification or assistive listening devices. The underlying fears will often emerge out of those discussions. Continue reading

Patient Education: The Flip Side of Audiologic Counseling

Kris English, Ph.D.Kris English, PhD

The University of Akron/NOAC

Audiologic counseling is like a two-sided coin: one side attends to patients’ emotional and psychological struggles, and the other side, to their need for clear, relevant, and compelling information. Goleman (1995) would describe these two goals as communicating either with the “feeling mind” or the “thinking mind.” The concept of “being of two minds” is a familiar one, but communicating with a patient’s “thinking mind” (more specifically, our efforts in patient education) hasn’t attracted much attention in audiology.

Patient education can be taken for granted,  but that would be a grave mistake. If not careful, we might apply a range of ineffective practices, such as:

  • Using words our patients can’t process;
  • Providing more detail than patients can remember;
  • Conveying information unrelated to patients’ questions;
  • Providing information without helping patients apply it to their lives.

Let’s ponder that last point for a moment. Information designed to “help patients apply it to their lives” elevates patient education to a new level of responsibility. We are not only talking about providing information, but also using information as a vehicle for change.

This concept is relatively new. Falvo (2011) notes that while “many people think of patient education as the transfer of information … the real goal is patient learning, in which patients are not only provided with information, but helped to incorporate it into their daily lives” (p. 21). We are being invited to redefine this process, to evolve from a monologue of information-giving into an interactive framework for change.

The concept of “effective patient education” can be new territory for many audiologists. How do we find our way? This article outlines a suggested checklist to guide us, applying classic teaching/learning principles culled from exemplar patient education materials.

A Checklist for Audiology

Patient education has a familiar starting point: knowledge dissemination.

Knowledge Dissemination. We have much information to share about test results, anatomy, etiologies, genetics, recommendations, treatments. However, as part of effective patient education, this step is just the first of several considerations. Even as we disseminate information, we cannot assume the patient understands us, or will remember what we said accurately. Let’s consult this checklist of concerns:

Slide1

As we disseminate knowledge:

Does our patient understand us? In addition to the problems with professional jargon, we must remember that when a patient is upset, the amgydala in the brain activates “flight or fight” responses (increased heart and respiration rates, etc.). While in this state, the frontal cortex (the center for analysis and reasoning) is inaccessible. We might be talking to a brain that, for the time being, cannot learn. How to test for understanding? The easiest way is to ask: “Would you like a detailed explanation, or a big-picture summary? Do you prefer information conveyed verbally, or in writing, or both?” And later, “To be sure we are on the same page: could you share with me your understanding of the situation?” Asking the patient to repeat what they understand is called the “teach-back method” (Agency for Healthcare Research and Quality, 2010). Continue reading

When We Think “Adult Patient,” Do We Also Think “Family”?

Kris English, Ph.D.Kris English, PhD

The University of Akron/NOAC

Whether we scan our bookshelves, review our folders, or – more likely – enter keywords in a search engine, we are likely to find the terms “family” and “hearing loss” almost exclusively associated with children and their parents. Interestingly, apart from a few exceptions (e.g., the National Council on Aging), adult patients with hearing loss are not immediately linked to the context of family. We have valuable information on the role of our adult patients’ communication partners (e.g., Preminger & Lind, 2012), but it seems important to point out that family means far more than communication. Historically, family has also meant moral, financial, and logistical support, “a feeling of belonging … honesty, trust and unconditional love.

Perhaps audiology has paid little attention to what it means to serve adult patients in a family context because we assume it is a “given.” However, some recent research indicates we should give this topic deeper consideration, and not take our practices for granted.

By “Family,” We Mean …45891913_s

Families are universal in all cultures, but definitions vary widely. A simple, popular, and inclusive definition is “two or more people who consider and define themselves as a family.” Another inclusive definition is “any group of intimates with a history and a future” (Ransom & Vandervoort, 1973). Biological and legal ties are traditional but not required. It is likely all readers know of someone who was “adopted” as a cousin or aunt or brother because of long-standing involvement and support that transcended simple friendship. To be “considered family” when not actually related is usually accepted as a high honor.

How Families Function Continue reading

Ear to the Ground: The Value of a Patient’s Story

sundarGirija_audGiri Sundar, MPhil/PhD

Osborne College of Audiology Director, Distance Education

Salus University

As a clinical audiologist for over 25 years, I have encountered numerous people with hearing loss, only to conclude that this is not a homogeneous group. What differentiates each patient is his or her unique story; fortunately for us, if we allow the story to unfold, we will learn how to help. Here is an example:

One of my patients described a get-together in the family. He has three children and five grandchildren. They had all arrived from different parts of the northeast, and he had not seen them together in some time. Once the entire clan was in the dining room, everything (chairs, cutlery, plates, people, mouths) was in constant motion. The dining table was the only thing that did not move.

41785891_s

My patient’s eyes could not quite keep up with the pace of activity; dependent on the visible word, his social encounters were manageable when limited to roomful of one or two people, and he’d developed his own strategies to cope with his hearing loss in simple listening conditions. But too many people in one room with the scattered sources of sounds left him unnerved.

Sounds blended together in a din and he retreated into the sanctuary of his study, leaving his dinner unfinished. He could not tolerate the blurring of words; he could not participate or even spectate. The very people he loved seemed insufferable and tiresome. His retreat, however, was misconstrued by his grown children and created quite a bit of tension in the following days. His wife’s observation of the possibility of hearing loss being at the root of this behavior allowed the rest of the family member to somewhat understand this gentleman, and upon his daughter’s insistence he decided to seek some help.

He was quite forthright when I asked him what made him see an audiologist at this particular time. Although in the beginning he only wanted a hearing test, routine questions regarding his communication difficulties brought his real story: he felt an alienation from his family.

He often had to imagine what they might be saying. “No one wants to listen or take the time to listen. Going out with people you comfortably socialized with has become something of an ordeal…it is claustrophobic; when you are in the middle of a group of people and cannot participate in the conversation, it is as though the people around you suffocate you. You know what I mean?”

I asked him if he wanted hearing aids. He did not: he only wanted to know if he had bad hearing loss. The answer told me my patient did not yet realize himself that the issue was his hearing problem (unique to him and his life), not his hearing loss. Because I understood his story, I could help him make the connection between his hearing loss and the alienation that had been hurting him so much.

 

The Most Important Instrument in Audiology

Kris English, Ph.D.Kris English, PhD

The University of Akron

From 1999-2009, I had the opportunity to teach an online course in counseling for audiologists earning an AuD through the Central Michigan University/Bill Wilkerson Center Vanderbilt University distance education program. It will seem hard to believe now, but when the AuD program started, many enrollees had little experience with email, so to get the ball rolling, the first assignment was to complete the Keirsey temperament questionnaire and email me the results (Rational, Artisan, Idealist, or Guardian).  My two goals were to jump-start the “know thyself” process and to help students become familiar with my email address.  I wasn’t looking for any trends, but … take a look:2015data

Ten years and 25 semesters later, with results from 390 audiologists (all with MA degrees and an average of 15 years experience), the summative data show a very strong tendency toward Guardian temperaments (82% in the middle bar, compared to 40% in the general population on the left). Since then, I have posed the same assignment to AuD graduate students (from 2008 to 2014, right hand bar), and have also frequently asked attendees at workshops to spend 10 minutes on this exercise, with very similar results. For instance, among 27 practitioners in a recent workshop, our results were 0% Rationals, 18% Artisans, 15% Idealists, and 67% Guardians.

“Knowing Thyself” Stimulated Change   Continue reading

Parents Teaching Students

Vasil AAAKara Vasil, Class of 2016

The University of Akron/NOAC

Picture this: You are in the sound booth, right in the middle of an audiologic assessment. A few missed head turns or latent ABR waves in, you realize that maybe these parents’ fear has been realized, and their child has a hearing loss. They’ve sat in your office, putting the puzzle pieces together of the child’s birth history, medical complications, and behaviors in the home. You now have concrete evidence, in the form of behavioral testing, an ABR, OAE’s, or whatever it may be. Now it is time to break the news to these parents that their child has a hearing impairment. Whether they are expecting it or not, you, the audiologist, have a job to do.

Despite coursework in pediatrics, counseling, and aural rehabilitation, many graduate student clinicians have never been in this situation. Even when evaluating pediatric patients of all ages and walks of life, the majority have not yet concretely identified and reported to parents a permanent, sensorineural hearing loss. As many clinicians would agree, I do not believe this is a skill that can be taught solely in the classroom. Some may feel that there has been a barrier between the clinician and the parent – what is appropriate to say, and what are these parents thinking about when they leave the office and return home with their child?

Learning from the True Experts

This past semester, that barrier crumbled a bit. In a pediatric amplification course, my professor, Dr. Mark Krumm, brought in four parents of children with hearing loss. These parents were all from the local area and had met in a support group. Their children had sensorineural hearing loss of varying degrees and were treated with hearing aids and cochlear implants, technology that I consider myself quite familiar with. However, one thing I do know is that it’s not about the technology. Hearing these parents’ testimonials about their relationships with their audiologists, their children, and their families was a truly eye-opening experience. The experience reminded my entire class that the parents of our pediatric patients are trying their best and have heartfelt compassion for their kids, and, no surprise – they know their children a whole lot better than we do. These parents know what makes their children tick, they know what the technology will and will not accomplish in their home, and they also probably know their audiologist’s cell phone number for when they will inevitably need it.

The parents who visited my class talked about the desire for a trusting, collaborative relationship with their audiologist, with referral to the appropriate professionals when we just don’t have all of the answers. An article published in the American Journal of Audiology confirmed these statements; parents and caregivers want their voices to be heard, and they want their child’s treatment implemented in a coordinated and professional manner. Fitzpatrick, et al. (2008) interviewed 21 parents about the strengths and weaknesses of the standard audiologic care system. Although most parents were satisfied with the range of services provided and the quality of services, they did have a few suggestions for us to consider. Family-centered care and a high level of support have been linked with higher rates of follow-up, better participation in early intervention services, and ultimately improved outcomes for the child.

ahaTwo Things Click

After listening to these parents on that otherwise-average Wednesday, two insights have stuck with me.

  • The clinician leaves the office at the end of the day and may not communicate with the family until the appointment nears. In the meantime, parents, family member and caregivers spend most waking hours with the child every day! And those hours can be “messy.” Children and their parents need breaks from the technology sometimes. They will likely lose a hearing aid or two. Earmolds will need to be remade routinely. Children get sick, teeth, and have bad days, which impacts amplification use. Families need their audiologist to provide not only information, but empathy for those challenges.
  • One mother became emotional while talking to our class. She reported that, yes, hearing aids do sometimes get wet, and children do sometimes get hurt while playing sports. But what kind of childhood would their son or daughter have if they were kept from participating in all of the activities that they loved? Gymnastics, swimming, volleyball, horseback riding, and simply playing in the backyard are all activities that typically hearing children participate in; why should a child with hearing aids or cochlear implants behave any differently?

If we as audiologists can recognize a family’s unique needs, we can ensure the child obtain not only access to all of the necessary auditory stimuli but also access to healthcare professionals, educators, and other families. If and when problems do arise, they will become that much easier to solve when the family-audiologist relationship is built on mutual trust and understanding.

familycentered

Reference

Fitzpatrick, E., Angus, D., Durieux-Smith, A., Graham, I.D., & Coyle, D. (2008). Parents’ needs following identification of childhood hearing loss. American Journal of Audiology, 17, 38-49.

Gradual Hearing Loss and Sensemaking

Kris English, Ph.D.Kris English, PhD

The University of Akron/NOAC

Recently, a friend described how her grown son currently chooses to be homeless. She doesn’t know how to find him, and doesn’t know how he manages. Needless to say, she is worried sick. Looking back, she now recognizes the early signs of mental health problems during his teen years, but at the time, she didn’t recognize them as such. After all, it’s not unusual for teens to be rebellious, non-communicative, disorganized, or moody. As any parent would, she applied what she knew in general about adolescence to make sense of her son’s decisions and actions; only when her explanations no longer made sense (this is not how teens typically act) did she feel ready to consider broader, more complicated explanations and seek help. The diagnosis of mental health problems was a first step toward making sense of a profoundly unfamiliar situation.

Most adults approach life’s uncertainties in the same way: we experience something we don’t fully understand and start by working through “what we know.” Our car makes a funny noise so we look under the hood. We notice a new ache or pain, and make changes in our diet or environment (maybe more exercise?). Our computer freezes so we turn it off, count to ten, and turn it back on. In doing so, we are applying the sensemaking process, which helps us understand a change or shift in our world. If that process fails us, we consider taking the next step of asking someone for help.

Although much of audiologic counseling focuses on emotional and psychological reactions to hearing loss, our patients of course are also decision-making individuals whose minds seek logic, facts, and answers that make sense. Here we will consider how the sensemaking process applies to our patients as they ask for our help.

It Might Look Like Denial

Sensemaking in health literature is often applied to the diagnosis of a life-altering disease or disability (e.g., Pakenham, 2008), as in “why is this happening to me?” and “what will become of me?” Acquired hearing loss is certainly a life-altering condition, and both patients and audiologists attempt to make sense of it. We understand our role: in our initial encounter with a new patient, we begin with the query, “What brings you here today?” to help us understand the patient’s concerns, and then we test. However, we may not understand that the patient is also striving to make sense of this appointment. For many patients, a gradual hearing loss does not yet make sense, as reflected in these remarks:

  • My family says I can’t hear them – but that can’t be true because I definitely hear them complain!
  • People speak too fast these days.
  • It’s not my hearing, it’s the background music on TV that’s the problem.
  • How can anyone be expected to hear in such noisy restaurants? They used to be quieter.

Gill et al. (2010) describe these types of comments as “candidate explanations,” offered to convey a patient’s efforts to make sense of the situation. However, we may be inclined to interpret these comments as denial (or stubborness, embarrassment, suspicion) instead of reasonable efforts to understand a problem based on what the patient currently knows: that one’s hearing seems to be generally adequate.

What patients don’t yet know is their actual hearing status. How we go about informing them can support the sensemaking process.

Do We Inadvertently Impede the Sensemaking Process?

 Knowing that many patients are trying to make sense of our time together, we have to ask ourselves if we help or hinder that process. Consider the information that we collect but do not share with patients until our testing is done:

  • During pure tone tests, patients have no idea of the intensity required to define their thresholds. Whether it was 20 or 70dB, as far as they know, it was soft and therefore assumed to be “good” hearing.skeptical copy
  • During word recognition tests, patients receive no feedback about the words they misheard, and are often shocked to be told they missed any at all.
  • During speech-in-noise tests, patients recognize at some point that the noise is a problem, but they don’t know that their abilities may be far from normal.

Their hearing concerns now make sense to us, but so far the patient has been kept in the dark. When we do convey test results, we must understand why some patients will still be skeptical, challenging, or confused. Our summary can be quite inconsistent with what makes sense to them (that they can hear fairly well). Can we do better?

Sensemaking as a Social Process Continue reading

Audiology and End of Life

headshot for AACLaura Rickey, Class of 2017

The University of Akron/NOAC

First, I would like to share the story that inspired me to write about this topic. Dr. Kristina English shared it with me after a hearing screening. The story is as follows:

 

A family had been given the news that their grandmother’s illness had received every available treatment, and it was now time to think about keeping her comfortable in respite care.  The patient had been a hearing aid user in the past but while managing several recent emergencies, the family realized the hearing aids were lost.  Now that the grandmother’s pain was under control, she wanted to talk to every one of her beloved family members — although she could talk, she couldn’t hear their responses.  So the family found the audiologist who had fit the most recent set of hearing aids and asked for help.  New hearing aids were quickly provided and the family made full use of them, sharing memories and stories, and laughter and tears with the grandmother for as long as she was able.  The time did not last long, however, and she peacefully passed away 10 days later.  The audiologist was contacted about her passing and also the memorial service.  She told the family she would arrange for a refund, but they declined.  They reported that they “got more than their money’s worth” in those 10 days, and they would rather have the audiologist hold on the devices for other families who could use the same kind of help.  The audiologist followed their wishes, and has lent the devices to other families in the same end-of-life situation. The devices are lightly engraved with the words, “Use with Love.”

After hearing this extremely powerful story relating to the end of life and audiology, I decided to try and find out more about this topic. I came to find that there is very little information in the literature about the end of life and audiology. This came as a surprise to me, as audiologists serve a population with whom the end of life topic must be considered. This got me wondering if, as professionals concerned with communication, are we focusing most of our interests on early life, and possibly negating a very important part of life, that is death? In the book, Death and Dying, Life and Living, the ideal is shared that death is a very important part, if not one of the most important parts of individual’s life. There is absolutely no doubt that it is important to make sure that children receive auditory input as soon as possible, but are we focusing so much on this aspect of audiology, that we are forgetting about other times in life that communication is of the utmost importance? Is it possible that the first few moments, weeks or years are just as important as the last? Do audiologist have a place in end of life care? Is it ethical to recommend amplification at the end of and individual’s life? These are all questions that, in my opinion, need answers.

Do we Have a Place in End-of-Life Care?19458894_s
According to the National Hospice and Palliative Care Organization (2011), hospice provides expert medical care, pain management, and emotional and spiritual support not only for the patient, but also for the patient’s loved ones. Hospice care involves an interdisciplinary team of specialists including; the patient’s primary physician, hospice physician or medical director, nurses, home health aides, social workers, bereavement counselors, clergy or other spiritual counselors, trained volunteers, and speech, physical, and occupational therapists, if necessary. Audiologists are not currently listed as interdisciplinary team members for hospice and palliative care, but should we be? Continue reading