title: The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations.
abstract: BACKGROUND
  Effective practitioner-patient communication throughout diagnosis and management planning positively influences patient outcomes. A patient-centered approach whereby patient involvement in decision making is facilitated, a therapeutic relationship is developed, and information is bilaterally exchanged in an appropriate manner, leads to improved patient satisfaction, adherence to treatment, and self-management. Despite this knowledge, little is known about the nature of audiologist-patient communication throughout diagnosis and management planning.
  
  
  OBJECTIVE
  This research aimed to explore verbal communication between audiologists and patients/companions throughout diagnosis and management planning in initial audiology consultations. Specifically, this study aimed to describe the nature and dynamics of communication by examining the number, proportion, and type of verbal utterances by all speakers (audiologist, patient, and companion when present). In addition, this study aimed to investigate the influence of audiologist, patient, and consultation factors, such as verbal dominance, content balance, and communication control, on the dynamics of communication.
  
  
  METHODS
  A total of 62 initial audiological rehabilitation consultations (involving 26 different audiologists) were filmed and analyzed using the Roter Interaction Analysis System. All patients were older than 55 yr, and a companion was present in 17 consultations.
  
  
  METHODS
  This study focused solely on the communication relating to diagnosis and management planning (referred to as the "counseling phase"). Diagnosis, recommendations, rehabilitation options, and patient decisions were recorded along with the communication profiles and communication dynamics measured using the Roter Interaction Analysis System. Associations between communication dynamics (content balance, communication control, and verbal dominance) and eight variables were evaluated with Linear Mixed Model methods.
  
  
  RESULTS
  The mean length of time for diagnosis and management planning was 29.0 min (range, 2.2-78.5 min). Communication profiles revealed that patient-centered communication was infrequently observed. First, opportunities to build a relationship were missed, such that patients' psychosocial concerns were rarely addressed and patients/companions showed little involvement in management planning. Second, the amount of talk was asymmetrical and the majority of audiologists' education and counseling utterances related to hearing aids; yet, only 56% of patients decided to obtain hearing aids at the conclusion of the consultation. Hearing aids were recommended in 83% of consultations where a hearing loss was diagnosed and alternative options were rarely provided. Thus, shared decision making rarely occurred, and audiologists often diagnosed a hearing loss and recommended hearing aids without patient involvement. In addition, when a greater proportion of time was dedicated to diagnosis and management planning, patients had greater input and control by asking more questions and requesting further information.
  
  
  CONCLUSIONS
  Patient-centered communication was rarely observed in the 62 consultations. Thus, although not measured in this study, patient outcomes are likely to be affected. Future research should examine the influence of audiologist communication on outcomes and encourage a shift toward patient-centered audiological rehabilitation.
authors.affiliation: The HEARing CRC 550 Swanston St, Carlton, Victoria 3053 Australia; Department of Audiology and Speech Pathology, the University of Melbourne, Melbourne, Victoria 3053 Australia.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Grenness
authors.affiliation: The HEARing CRC 550 Swanston St, Carlton, Victoria 3053 Australia; Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland 4072 Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Hickson
authors.affiliation: Eriksholm Research Center, Oticon A/S 20 Rørtangvej 3070 Snekkersten, Denmark; Linköping University, Department of Behavioral Sciences and Learning, 581 83 Linköping, Sweden.
authors.forename: Ariane
authors.initials: A
authors.lastname: Laplante-Lévesque
authors.affiliation: The HEARing CRC 550 Swanston St, Carlton, Victoria 3053 Australia; Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland 4072 Australia.
authors.forename: Carly
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Audiology and Speech Pathology, the University of Melbourne, Melbourne, Victoria 3053 Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Davidson
mesh_terms: D012048:Correction of Hearing Impairment / Q000379:methods*; D003657:Decision Making; D005260:Female; D006310:Hearing Aids; D034381:Hearing Loss / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction; D012017:Referral and Consultation; D012648:Self Care