Supporting the Patient Journey Is an Evidence-Based Practice

This issue of Seminars in Hearing focuses on the work developed by the Ida Institute, an independent, nonprofit educational entity located in Copenhagen, Denmark. The Ida Institute is funded by a grant from the Oticon Foundation, and is named in honor of Mrs. Ida Demant, the wife of the Oticon Foundation founder. Its mission is deceptively simple: “To foster better understanding of the human dynamics associated with hearing loss.”

To explore these dynamics, the Ida Institute has conducted almost a dozen “think tank” seminars in the last 3 years, engaging audiologists from across the globe as Institute Fellows. Part of this process involves a unique opportunity to work with a team of anthropologists, enlisted to study our profession as a culture. As impartial observers of our practices and as faithful collectors of patient stories, our new anthropology friends are helping us see ourselves with fresh eyes, giving us new vocabulary to understand our patients' journeys, and inspiring Institute Fellows to design new tools to help us counsel and communicate more effectively with our patients.

More than just a nice idea, effective patient communication is an evidence-based practice, having a direct impact on patient adherence. A recent meta-analysis[1] conducted a literature search ranging across 60 years (1949 to 2008), examining the results of 106 correlational studies and 21 experimental interventions. From these studies, the authors found a strongly positive and significant relationship (p < 0.001) between respondents' adherence and their physicians' communication skills.

The meta-analysis also indicated that communication training increased the likelihood that patients would adhere to physician recommendations by 62%. Their takeaway points: effective counseling is a teachable/learnable skill, and it is efficacious. The authors concluded that health care providers improve adherence rates by earning their patients' trust as a careful listener and patient-centered communicator.

Trust may seem a characteristic that is hard to define and yet “we know it when we see it.” However, Thom et al help by defining trust as “the acceptance of a vulnerable situation in which the truster [e.g., the patient] believes that the trustee [e.g., the audiologist] will act in the truster's best interests” (see p. 125 of Thom, et al).[2]

Trust can be measured as well as defined. Audiologists do not yet have methods to measure trust, but medicine has been doing so for many years. For instance, Fiscella et al collected data from 100 physicians who consented to allow two standardized patients to anonymously visit their practices and audiotape their conversations.[3] Transcripts of the conversations were coded to measure patient statements related to symptoms, ideas, expectations, feelings, and the effect of symptoms on functioning. Physician responses also were coded as a nonresponse, a preliminary exploration, a preliminary and further exploration, or validation. Interruptions and active “cutoffs” also were coded.

In addition, the standardized patients (as well as 4746 actual patients) completed a survey that included a “trust subtest.” Results indicated that specific verbal behaviors were significantly associated with patient trust ratings, including “eliciting and validating the patient's concerns, inquiring about and legitimating patients' ideas and expectations, assessing the impact of the symptoms on functioning and responding to patient clues to emotional distress by using empathic language” (see p. 1054 of Fiscella, et al).[3]

Let's connect the dots: effective counseling supports the development of patient trust; increased trust increases patient adherence. Because audiology is especially challenged regarding patient adherence, we must give particular consideration to the communication and counseling skills that engender trust.

As the subtitle of this issue indicates, the contributors to this issue contend that the Ida Institute (its faculty and Fellows) is redefining audiological treatment and management. The articles within explain why: much of Ida's work in the last 3 years involves developing a set of counseling tools and techniques with the express purpose of helping us conduct more patient-centered communication. These tools, and their philosophical underpinnings, are the beginning of a new era in audiological treatment and management.

• References

• 1 Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009; 47: 826-834
• 2 Thom D, Hall MA, Pawlson LG. Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood) 2004; 23: 124-132
• 3 Fiscella K, Meldrum S, Franks P , et al. Patient trust: is it related to patient-centered behavior of primary care physicians?. Med Care 2004; 42: 1049-1055