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future “family education” sessions, she helped
the family move beyond its stressful impasse.
A New Framework for Audiology: The
Family is the Patient
Obviously, not all families are healthy and
supportive, and not all patients are interested
in restoring family relations. We know from
experience that some families will not agree
on much, including the impact of hearing
loss or the need for hearing help. Sometimes
family members disengage from the process
altogether. Obviously, audiologists are not
However, it’s the rare
patient who has no “family” in his or her life
(in the broadest definition, to include friends
and communication partners, per Singh et
al1), and we cannot deny the impact support-
ive families can have on patient success.
complicated as families might be, we would be
remiss to exclude them from patient care. As
a first step in understanding family-centered
care, we could contemplate a basic principle
already consistently applied in pediatric audi-
ology14: that in family-centered care, the family
is the patient.
When the family is our patient, our out-
come questions change accordingly: Is the
family happy, satisfied, generally adjusting
well? To date, we do not have a valid way in
audiology to answer these questions.
Where Do We Go From Here?
Not surprisingly, managing difficult
conversations requires advanced skills. For
instance, Browning et al17 describe a set of
“difficult conversation competencies” which
n Comfort with our own imperfection and
n Expecting—not avoiding—uncertainty,
ambiguity, and complexity.
Readers will likely agree that these per-
sonal characteristics are not typically dis-
cussed in audiology. The lack of attention to
“who we are” and the issues of control and
power in these encounters probably explains
a comment the first author recently heard at
a conference: “...As long as they (patients/
families) think they are getting their way...”
The encouraging news is, becoming comfort-
able and effective with difficult conversations
is a teachable and learnable skill.
is much more to learn as well, and future
articles will contribute to our understanding
of family-centered care in audiology. ◗
This article is part of the ongoing collabo-
ration of the Phonak Family-Centered Care
Expert Circle, which includes the authors and
Ora Buerkli-Halevy, Vice President Global
Audiology, Phonak AG; Bill Dickinson,
AuD, Vice President Audiology, Phonak;
Louise Hickson, PhD, panel chairperson and
Professor of Audiology and Head of the School
of Health and Rehabilitation Sciences at The
University of Queensland, Brisbane, Australia;
Nerina Scarinci, PhD, Senior Lecturer, Speech
Pathology and Audiology, The University of
Queensland, Queensland, Australia; Stefan
Launer, PhD, VP of Science and Technology,
Phonak AG and Adjunct Professor at The
University of Queensland, Queensland,
Australia; Ulrike Lemke, PhD, Senior
Researcher, Phonak AG; Sigrid Scherpiet, PhD,
Research Psychologist, Phonak AG; Gurjit
Singh, PhD, Senior Research Audiologist,
Phonak AG; Barbra Timmer, MACAud,
MAudSA, MBA, Research Audiologist and
PhD Candidate, University of Queensland,
1. Singh G, Hickson L, English K, Scherpiet S, Lemke U,
Timmer B, Buerkli-Halevy O, Montano J, Preminger
J, Scarinci N, Saunders G, Jennings MB, Launer S.
Family-Centered Adult Audiologic Care: A Phonak
Position Statement. Hearing Review. 2016;23(4):16.
Available at: http://www.hearingreview.com/2016/03/
2. Stone D, Patton B, Heen S. Difficult Conversations:
How to Discuss What Matters Most. NY: Viking
3. English K, Kooper R, Bratt G. Informing parents of their
child’s hearing loss: “Breaking bad news” guidelines
for audiologists. Audiology Today. 2004;16(2):10-12.
4. Hutchinson P. The “real” tinnitus story: Lessons
learned about true patient-centered care. October
2014. Available: http://advancingaudcounseling.
5. Schön D. Educating the Reflective Practitioner: Toward
a New Design for Teaching and Learning in the
Professions. San Francisco: Jossey-Bass;1987.
6. Martin E, Mazzola N, Brandano J, Luff D, Zurakowski
D, Meyer E. Clinicians’ recognition and management
of emotions during difficult healthcare conversations.
Patient Education and Counseling. 2015;98:1248-1254.
7. Grenness C, Hickson L, Laplante-Levesque A,
Meyer C, & Davidson B. Communication patterns in
audiological history-taking: Audiologists, patients and
their companions. Ear Hear. 2015;36(2):191-204.
8. Gardner H. Changing minds: The Art and Science of
Changing Our Own and Other People’s Minds. Boston:
Harvard Business School Press;2004:57.
9. Pipher M. Writing to Change the World. New York:
10. Adams K, Cimino J, Arnold R, Anderson W. Why
should I talk about emotion? Communication
patterns associated with physician discussion of
patient expressions of negative emotions in hospital
admission encounters. Patient Education and
11. Ekberg K, Grenness C, Hickson L. Addressing
patients’ social concerns regarding hearing aids within
audiology appointments for older adults. Am J Audiol.
12. Clark J, English K. Counseling-infused Audiologic
Care. Boston: Allyn & Bacon;2014.
13. Institute of Medicine. Crossing the Quality Chasm:
A New Health System for the 21st Century.
Washington, DC: National Academy Press;2001.
14. Harrison M. Facilitating communication in infants and
toddlers with hearing loss. In: Seewald R, Tharpe
AM, eds. Comprehensive Handbook of Pediatric
Audiology. San Diego: Plural Publishing;2016: 829-
15. Allmond B. The Family is the Patient: Using Family
Interviews in Children’s Medical Care. Baltimore:
Williams and Wilkins;1999.
16. Meyer E et al. Difficult conversations: Improving
communication skills and relational abilities in health
care. Pediatric Critical Care Med. 2009;10(3):352-359.
17. Browning DM, Meyer EC, Troug RD, Solomon MZ.
Difficult conversations in health care: Cultivating
relational learning to address the hidden curriculum.
Medical Education. 2007;82:95-113.
18. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-
Edwards K. Approaching difficult communication
tasks in oncology. Cancer Journal for Clinicians.
19. Epner D, Baile W. Difficult conversations: Teaching
medical oncology trainees communication skills one
hour at a time. Academic Medicine. 2014;89(4).
20. Meyers L. Counseling today: All in the family.
September 2014. Available: http://ct.counseling.
CORRESPONDENCE to Dr English
at: email@example.com. To learn more
about the Family-centered audiolo-
gy care initiative, email Ora Buerkli-
Halevy at: firstname.lastname@example.org
As a first step in understanding family-centered care, we could contemplate a basic principle already
consistently applied in pediatric audiology: that in family-centered care, the family is the patient.
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