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

We can’t be expected to become family experts, especially since even experts contend that “Every family is the same. Every family is different.” By definition, though, families are generally interconnected and interdependent: in other words, what affects one family member to some degree influences the unit. Regarding health care, it has long been observed that families shape patients’ beliefs and attitudes about health, lifestyle, and health care (Lipkin, 1996), and that families often help patients make decisions about how and when to seek health care, take medications, follow prescribed diets, etc. (Jecker, 1990; Reust & Mattingly, 1996).

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(I know you are speaking, but what are you saying?)

When the health problem is a hearing loss, interconnectedness again comes into play. Hearing loss directly interferes with interconnectedness; when a loved one starts missing out on family life, it matters to family members to obtain help. In a very real sense, hearing loss is a family problem.

Working Effectively with Families

Even with a strong feel for what family means, it’s unknown whether, as a profession, we work with families effectively. A recent study (Grenness et al., 2015) indicates that we may not know how to incorporate families into discussions and recommendations. The researchers found that family members were not typically invited to join conversations during appointments, therefore likely accounting for their tendency to answer questions directed toward the patient. What an audiologist might perceive as an unwelcome interruption could be an understandable effort to be included. Another recent study (Ekberg et al., 2014) indicates that when differences arise between patient and family, audiologists often struggle to find to way to help the family unit work together in rehabilitation.

What We Don’t Know About Adult Patient Family-Centered Care: A Lot!

Once we start thinking about adult patients in the context of their families, many questions come to mind. For starters:

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  • Is there a difference between patient-centered dialogue and family-centered conversation? And if so, what skills are needed to fully include the family?
  • When family tensions present during an appointment, how do we respond? Although we are not professional therapists, do we have any counseling skills to offer in these moments?
  • What are our biases relative to family-centered hearing care?

Since 95% of our patients are adults, it would behoove us to understand the full impact of hearing loss on each patient’s unique family, and engage each family’s support to optimize rehabilitation. Families are asking us to pay attention to them as well as their loved ones; if we were the family members, we’d be asking for the same attention.

References

Ekberg K, Meyer C, Scarinci N, Grenness C, & Hickson L. (2014). Disagreements between clients and family members regarding clients’ hearing and rehabilitation within audiology appointments for older adults. Journal of Interactional Research in Communication Disorders, 5, 217-244.

Grenness, C., Hickson, L., Laplante-Lévesque, A., Meyer, C., & Davidson, B. (2015). Communication patterns in audiologic rehabilitation history-taking: Audiologists, patients, and their companions. Ear & Hearing, 36(2), 191-204

Jecker N. (1990). The role of intimate others in medical decision making. Gerontologist, 30(1), 65-71.

Lipkin M. (1996). Patient education and counseling in the context of modern patient-physician-family communication. Patient Education and Counseling, 27(1), 5-11.

Preminger J, & Lind C (2012). Assisting communication partners in the setting of treatment goals: The development of the Goal Sharing for Partners strategy. 
Seminars in Hearing, 33(1), 53-64.

Ransom DC, & Vandervoort HE. (1973). The development of family medicine: Problematic trends. JAMA, 225,1098-102.

Reust C, & Mattingly S. (1996). Family involvement in medical decision making. Family Medicine, 28(1), 39-45.