Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care

Abstract

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.

Keywords: audiology; decision-making; evidence-based practice; patient-centered care.

Figure 1.

Percentage of articles over time, in audiology journals, that mention evidence-based practice (EBP) and patient-centered care (PCC).

Figure 2.

Illustration of the combination of sources of information identified by audiologists to the question: “In situations where the optimal solution for your client is not straightforward, how do you identify an appropriate recommendation?” Note that an exact proportional scaling and overlapping of six variables is not possible and this illustration is therefore a close-approximation.

Figure 3.

Illustration of the combination of sources of information identified by audiologists to the question: “When you have to make a difficult clinical decision and your sources of information are conflicting or contraindicating, what would you do?” Note that an exact proportional scaling and overlapping of six variables is not possible and this illustration is therefore a close-approximation.

Figure 4.

Level of perceived difficulty in making recommendations. The X-axis represents the percentage of audiologists who responded the specified level of perceived difficulty.

Figure 5.

Level of perceived confidence in appropriateness of recommendations. The X-axis represents the percentage of audiologists who responded the specified level of perceived confidence.