Centering on People: How Hearing Care Professionals Can Adapt to Consumers' Need and Outcomes

Abstract

Audiology is experiencing exponential growth in technology, service, and provision options. These advancements give hearing care professionals the opportunity to revise, potentially improve, and adapt to the modern hearing care landscape to better serve the modern consumer. Consumer needs guide care planning and delivery, with the goal of achieving outcomes that are important to both the consumer and the clinician. The changes available to the hearing care industry can also enable consumers' needs to be identified and served in a more holistic and personalized manner than has previously been possible. The purpose of this article is to explain and encourage hearing care professionals to adopt a mindset of doing whatever is reasonable and clinically appropriate to meet the need and desires of the consumer by implementing choice in service, technology, and channel across whichever model of care adopted by a provider.

Hearing care provision is amid its most drastic period of growth and adaptation in the wake of technological, services, and sales channel innovations. ¹ Adoption of innovation in service, channel, and technology has potential to encourage person-centered practices. ² Nevertheless, despite substantial evidence and growing consensus regarding the proper application of and capacity to uphold the standard of care while using, for example, teleaudiology methods, ^{3 4} clinicians remain reluctant to adopt new ways of delivering hearing care. ^{5 6 7} Arguably, the core objective of a hearing care professional is to support the well-being and audiological outcomes for those with hearing loss. While audiology strategies, processes, and tools are evolving, the focus on improving outcomes remains unchanged. ⁸

Globally, demand for hearing care professionals is increasing across both developed and developing world. ^{9 10} To meet the need of the consumer now and into the future, it is critical to understand how to best utilize current, or the need to create new strategies, processes and tools in our clinical care. Holder et al introduces a framework where the full variety of existing hearing care provision options can be recognized in common language. ¹ Consumers are increasingly able to research their own options for hearing care, and they are aware of the increased flexibility that is now possible. In hearing care, this is demonstrated by the rise of easily accessible information regarding goods and provision combined with direct-to-consumer provision methods. Consumer options in healthcare are no longer solely limited by the clinic. The hearing care culture is becoming more receptive to consumer demands, experiences, and decisions over where to receive their hearing care. ¹¹ As a result of this new dynamic, hearing care must recognize that it is now more important than ever to be adaptable and responsive to consumers.

With the implementation of choice in services, technology, and channel across any model of care a provider may choose, ¹ the purpose of this article is to encourage hearing health care professionals to adopt a new mindset of doing whatever is reasonably and clinically appropriate to meet consumers' need and wants. By doing this, hearing healthcare providers are putting the need of the person first, ¹² hopefully encouraging further improvement of consumer outcomes. The distinction between using a person-centered approach and standard current practice is discussed. Table 1 shows two instances of people who struggled in the past to commit to regular hearing aid use and may be evaluating their next step in hearing care. The various components of working to meet the need of consumers of hearing care will be broken down and discussed using the following two case examples.

Table 1. Profiles of two fictional case examples for personalizing hearing care.

Name:	Marc	Marsha
Age:	54	67
Location:	Metropolitan area	Rural, closest town is 40 km away
Family status:	Married, with 2 mid teenage children	Husband, senior dog
Vocational status:	Working full time	Farmer, nearing retirement in the next 5 y
Hearing journey status:	Hesitant to seek hearing help. Several hearing checks across 5 years before wanting to discuss strategies. Devices such as hearing aids were the only solution recommended. After a trial, Marc deemed his hearing aid journey to be unsuccessful	Relatively early adopter of hearing help—sought help as soon as noticed hearing and tinnitus impacting life. Has lots of questions and values reading information. Successful start to hearing aid use, renewal of fitting due
Current disposition to hearing care:	Apprehensive of the commitment to attend clinics, mixed emotions regarding hearing aid performance expectations	Positive expectations of clinic service and regarding hearing aid performance, some apprehension regarding flexibility of care available

UNPACKING NEED

Low adoption and adherence rates to hearing loss rehabilitation are on the rise, both before and after seeking intervention commonly in the form of hearing aids, indicating that there is still more to learn about the causes of these actions. ^{13 14} The question remains whether a clinically diagnosed hearing loss sufficiently compels a consumer to purchase a hearing aid. In other words, the hearing loss necessitates the use of a hearing aid, but unless the consumer is aware of and accepting of the hearing loss, they may refuse to use one. ¹⁵ The problem of who should get to allocate or decide a consumer's need is not clear. The responsibility of the hearing health care professionals is to support effective and clear identification of need. Doing so relies on qualified experience of the HCP and the consumer, balanced with considerate consumer-orientated collaboration skills.

Further unpacking of the need of our two case examples Marc and Marsha, we can ask questions to gain information pertinent to understanding the relevant factors in their prior experience and perceptions. Table 2 illustrates example questions that can be used to achieve this.

Table 2. Unpacking the initial understanding of information pertinent to unpacking the need for the case examples.

Name:	Marc	Marsha
Current motivation:	Mobile and video calls are increasingly difficult, and his teenage children are disengaging from ineffective communication	Increasing difficulty when conversing with customers at markets
Current pain point:	Impact of hearing loss on his ability to manage his work-related communications, potential disruption to his work to address hearing needs	Impact of hearing loss on her few but vital occasions to converse with customers, conflict between freedom of lifestyle and work commitments with access to clinical care
Help seeking history:	Trialed hearing aids 2 years ago, gave up as he did not feel devices delivered enough over the two clinic appointments attended	She has 5-year-old hearing aids that worked well for a couple of years but lost the habit of wearing them after one stopped working and she did not have the motivation to sort the issue
Access to clinic:	Works in the CBD but is very busy	Lives 40 km away from town, does travel twice a week to the town for errands and socializing

Defining the Need

Need as a noun is defined as something that is necessary to achieve an outcome. Auditory compensation, for example, is required to make sound audible, where the desired outcome for a person with hearing loss is to be able to hear it. The desired outcome thus dictates the interpretation of need. Auditory need is objective and relatively easy to address in the provision of hearing care. Non-auditory need, on the other hand, is nuanced and complex due to the subjective nature of individual need and desired outcomes. A consumer's perceived need and desired outcome will be impacted and shaped by many factors such as attitude, experience, and knowledge; however, it will always be the consumer who owns and defines these factors. This is reflected in the audiology competency standards in Australia and the United States. ^{16 17} The audiology standards typically refer to the hearing care consumer as a client ^{16 17} : a term felt to respect the consumer's active choice to procure hearing care as an active participant in hearing care. The term client, however, may be misinterpreted as a restricted relationship with a single provider for the client. A single provider to client relationship is arguably losing relevance on the modern hearing care landscape, as provision of devices and services is becoming increasingly uncoupled, allowing consumers to potentially seek products and/or services from multiple providers to suit their need. ¹ In keeping with the notion that the consumer is a participant in hearing care of their choosing, with no restrictions on the number or type of providers from whom they can seek assistance, this article will continue to use the term “consumer” rather than client. The hearing care professional and the consumer collaborate to determine the outcomes to be achieved from the hearing care being provided, according to American and Australian professional audiology standards. ¹⁷ It is important to ensure consumer needs guide not only outcomes but serve as the foundation for a holistic and person-centered hearing care journey for the consumer.

Marc's Need

A busy working CBD lifestyle impacts Marc such that not distance but disruption to his work is the greatest deterrent to seeking help for his hearing. Evidence from blended service models and consumer surveys indeed support that distance is not a primary motivator in deciding whether to consider clinic or online hearing care services. ^{18 19} Marc's job also means that an important communication need is reliable and versatile streaming capacity so he can have high volumes of calls and meetings on his phone and switch across devices as needed. The need for Bluetooth streaming therefore represents an auditory and non-auditory need at the same time. Outside of work, Marc is a very quiet man, spending time only in small groups as he disliked busy crowds finding them personally overwhelming. His children are teenagers and they present the most difficult auditory challenges. The level of stress from his work means he admittedly does not have much patience for learning new skills, so he would like ease of use for him, while having access to support that is flexible. He would be very happy to set and forget. His need includes supporting his job and reducing strain on family relationships and nonvocational stress.

Marsha's Need

As a busy country farmer, Marsha does not always have flexibility to visit her closest clinic, but wants assurance she can seek help there. Her most challenging environments are at markets where she needs to hear customers who come to her counter. She cannot afford to be out of action so to speak. At home, she often converses with her partner from across the house if they are not at the TV or dinner table. She likes to know what is possible, not knowing what she can do is more frustrating as she cannot plan what to do. Her non-auditory need will include a sense of control over her daily activities and access to the status of her hearing aids so she can avoid being let down on the go. Her need includes coping at markets, self-management, and maintaining control of her daily activities.

Defining the Outcome

Clinical practice guidelines recognize outcomes as “client-based” measures relating to personalized treatment objectives. As a result, consumer-reported subjective measures are the best way to assess outcomes. ^{20 21}

Evaluates client outcomes using client reported and/or objective measures ¹⁶

.. outcome measures to ensure that treatment goals of the patient have been met..... Validation through the use of outcome measures is completed subjectively by the patient. ¹⁷

Allocation and assessment of outcomes is fundamentally a person-centered practice and yet practicing person-centered care has been raised as a clinical challenge. ^{22 23 24} Person-centered care proposes that decision making and control, as represented in chosen treatment outcomes and degree of autonomy given, allow the individual (consumer of hearing care) to play an active role in their treatment plan and journey. In audiological standards of practice, there is a clear acknowledgment of supporting shared decision making and goal setting personalized in the form of chosen outcomes to aim for, supporting the notion that consumers' need and objectives extend beyond auditory compensation provided by a hearing aid. Goldstein and Stephens' auditory enablement model proposed treatment outcomes related to a consumer's environment, social context, emotional context, vocational context, and recreational context. ^{25 26} This holistic approach promotes person-centered care planning, in which the individual's outcomes are defined by their individual need, which in turn influences suitability for potential devices/care planning options. We are better able to consider how various forms of hearing care provision can or cannot effectively support given outcomes when we consider the person's need or treatment goals as the starting point of their hearing care. ²⁷

The availability of direct-to-consumer hearing aids has provided an opportunity to learn about the impact of modern hearing care aspects that are not represented in traditional clinic-based services. Hearing aid purchases made directly to consumers have been shown to have a potentially powerful effect on hearing care adoption and adherence. ²⁸ If one of the treatment goals is to facilitate individuals to adopt and use hearing aids, making it easier for people to obtain hearing aids should be considered. Non-auditory needs, such as self-efficacy, self-management, and support networks, have been shown to be key factors in the success of hearing care provision, ²⁹ all being person-centered domains. In an industry with a low rate of adoption and adherence, ^{13 14} hearing care and hearing aid provision can benefit greatly from redesigning services with needs-based thinking to serve person-centered goals and person-led outcomes measures as the primary measure of success. ³⁰ The proliferation of hearing devices other than hearing aids, service channels that are unconnected from clinics, and service provision that is consumer-led rather than clinic-led can provide a productive challenge to the traditional and habitual approach to assessing success, shifting it away from fitting a hearing aid toward consumer commitment to wearing their hearing aid.

Marc's Outcome

If Marc was asked what a successful outcome would look like, he may say that his work was not disrupted, he was able to access and adapt to hearing aids as easily as possible, and that he could set and forget. Online or direct to consumer provision of hearing aids may be the most convenient channel for him; however, he also needs a careful balance of available support to ensure he is receiving benefit from the devices while maintaining as much ease of use as possible. Teleaudiology support that is easy for him to set up and allows enough remote access to address his need may be a good fit for him to achieve the outcomes that are important to him.

Marsha's Outcome

Successful outcomes to Marsha may look like confidence to manage her work, a sense of control over hearing aids, a sense of support that is local when she can request it, and a more understanding partner who understands they should be in the same room to communicate with her. Communication training programs that can be supported remotely could add value for Marsha's hearing care provision in addition or combination with the chosen hearing aid package. A hearing aid package that includes an app-based diagnostic check, contact request, and video call option may allow Marsha to feel in control, able to plan with confidence, have support where her partner can be included at times, and knowledge she can attend a clinic at other times, especially for initial fitting so she can ask everything she would like to be confident with what she has. A hearing aid with a degree of teleaudiology support that is provided from a clinic sales channel may be the best fit for Marsha to achieve the outcomes important to her.

Need Is Adaptive

Hearing loss is a chronic condition that changes over time for most people. ³¹ As a result, the degree of hearing loss necessitates periodic reevaluation and adjustment to the hearing care provision, typically by updating and adjusting the amplification settings of a hearing aid being worn or replacing it in the process. Hearing aid life cycles are generally recommended to be between 3 and 5 years, which serve as common benchmarks for warranty periods and reimbursement schemes. By consequence the consumer journey can be mapped against business measures rather than consumer-centric measures. In practice, it is common to find changes in audiometric measures over time, and estimated rate of decline of speech perception abilities with hearing loss have been mapped to different rates according to whether hearing aids have or have not been used. ^{32 33} A pilot study looking at reassessment following hearing aid fitting after a 3-year period found all subjects did need adjustment to their hearing aid fitting and over half benefited from reassessment of their self-reported outcomes measures. ³⁴ The hearing loss journey is therefore an adaptive journey responding to changes in the hearing loss at the very least.

Changes in the consumers' need, however, can extend beyond hearing loss, potentially resulting in changes in preferences or suitability to service provision options too. More recent evidence from blended service model indicated up to a third of consumers chose to switch from direct to consumer sales channels to clinic-based sales channel and vice versa to upgrade their hearing aids, ³⁵ indicating the need to support change of need toward more comprehensive care as well as toward empowerment. Comorbidity is a concern in chronic health, such as hearing loss, whose incidence increases with age, increasing the likelihood of multimorbidity reality for the hearing care consumer population. ³⁶ The management of each health condition has an impact on the management of the others, making care planning potentially complicated because need and outcome are influenced by factors other than hearing aids and hearing loss. Taken together, there is audiological, medical, personal, and behavioral evidence for the need to provide hearing care services as an adaptive and holistic model of care in response to each consumer's constantly changing need. By no means does one size fit all.

Assessment tools for consumer outcomes are an integral part of audiological care. The most common tools focus on the benefit provided by the hearing aid (e.g., Client Oriented Scale of Improvement [COSI] and Glasgow Hearing Aid Benefit Profile [GHABP]). ^{20 21} The most holistic, person (consumer)-centered, outcome assessment tools available position the intervention (such as a hearing aid) as the subject of the outcome, with outcome often defined as providing auditory benefit. Care planning in audiology aims to be consumer-centric, holistic, and able to work with multimorbidity. To achieve this, there are very different considerations that need to be addressed according to auditory need and non-auditory need that do not always align. The audiological principle of use it or lose it, ^{32 33} meaning auditory capability, is the fundamental reason for encouraging long-term hearing aid use best indicated, but not dictated by, satisfaction. On the other hand, it is the non-auditory, complex, chronic-health understanding of the experience and impact of hearing loss on the person that will impact the broader desired outcomes and consequent need of the consumer. ^{26 37} In other words, clinical need for use of hearing aids alone has no value for a person who does not believe, want, or care about their hearing needs. Adaptation of technology, channels, and services has helped the ability to address modern psychosocial, environmental, and vocational needs of consumers. However, in practice, the prominent measure of success is typically tied to the intervention goal rather than the holistic priorities of the consumer who is living with the chronic condition. Modern hearing care delivery models may enable us to redesign outcome measurements to better represent the broader need of consumers living with hearing loss, in addition to current measurement tools of auditory benefit provided by hearing aids, resulting in a truly holistic, adaptive model of audiological care.

Marc's Experience-Led Need

When Marc first trialed hearing aids he attended two clinic appointments only, one to be fitted and the review in which he gave up and ended the trial. His original expectation was of a set and forget fitting that would require no adjustment and was to a degree unrealistic. He may initially have had expectations regarding performance among noise that were not met and led to his decision not to continue the trial. For his second trial, he begins the process with some knowledge that there is likely a need to interact after fitting, though he now knows it does not have to be in a clinic. He is also aware that sound performance is not likely to be a stark contrast for him; however, he is also now far more reliant on calls for his work and aware that streaming should be able to support his vocational need. His need and expectations shifted as a result of his first experience, from natural changes to his lifestyle.

Marsha's Experience-Led Need

The first hearing aid fitting and purchase Marsha underwent was at her local clinic. She had wanted to be seen and assisted face to face only, though found it was hard to make time from her farming commitments to organize follow-up appointments and eventually stopped trying. She had wanted to have full clinic support to be sure she could rely on her set up and not be caught short, which ended up happening eventually when one hearing aid stopped working on a day that she had a market to run. Marsha has now come to decide that she still values face-to-face clinical support most, but will also be more proactive in wearing her hearing aids and utilize tools that allow her to know on her own if her hearing aids are working, and also be able to manage some contact with the clinician when unable to attend an in-person appointment. By finding what caused her first hearing aids to cease being successful, she made new decisions, based on new information and has come to new expectations as to how she can best have her need met.

HOW HEARING CARE PROFESSIONALS CAN MEET CONSUMERS' NEED

Modern hearing care is challenging clinicians to adapt their services for a landscape that is increasingly consumer led. In the years following provision of a hearing aid, consumers are increasingly able to choose services that may be online or clinic based, from the same provider or another in much the same way that has been observed from blended models of hearing care. ³⁵ The use of various service types by consumers irrespective of the sales channel used to acquire hearing aids supports the fact that need can continue to change along the hearing journey. Hearing care providers therefore have an equal opportunity to respond to the consumers change of need and desired outcomes at any point in their journey, as has been well demonstrated by the emergence of online service–only teleaudiology providers that are uncoupled from the sale of a device and thus solely focused on assisting the rehabilitative journey for the consumer. ^{38 39} This is in essence a potential value proposition as a provider. The rise of innovation in technology, service capability, and sales channel options in different regions is creating greater ability for the hearing care professional to adapt how they can plan and support hearing care for more consumers at any part of their journey. ¹

A common assumption regarding factors underlying low rates of adoption and adherence in health care, such as audiology, has been the relevance of geographical distance or access to services. While evidence has supported distance being relevant to attendance for hearing aid review appointments that can address and reduce the reported number of problems, this relationship did not stand regarding outcomes. ⁴⁰ Further to this point, there is increasing evidence that geographic distance is not related to consumer choice of sales channel as seen in survey sampling of motivations ¹⁹ and consumer behavior data from hybrid service models. ³⁵ Taken together, the consumers' need and motivations toward various sales channels, and service models, are of upmost importance if we wish to assure effectiveness and quality of care across all provision models the consumer will seek.

A key factor that could be used to unpack this problem more effectively is to start with where the consumer is in their journey. As explained by Holder et al, the consumer's journey with hearing loss is a never-ending story for which no two points are the same. ¹² Hearing tests and fitting new hearing aids may be periodically repeated; however, each occasion fundamentally is based on needs that were shaped by the previous experiences and the passage of time with that experience at the very least. A younger consumer population are more likely to be still working, implicating their vocational need when selecting a flexible service offering. Those with untreated hearing loss typically comprises those who have not yet sought hearing help or those who have but did not find intervention with hearing aids successful enough to continue using them. In either case, being informed of a hearing loss and experiencing sound with a hearing aid (ideally successfully) for the first time are singular events. Once these have occurred, the consumer is no longer in doubt of whether these are true, but the transition instead becomes about believing or accepting what they hear. In other words, accepting a hearing loss or intervention for hearing loss is about more than hearing objective fact or improvement. Any continued efforts to avoid or reject hearing aids are fundamentally informed from that point on. Once a consumer accepts their hearing loss and/or the use of hearing aids, the hearing loss does not cease to exist thereafter. The consumer's experiences continue to build, leading to many potential success and failures along the way. Similarly, once successful intervention with hearing aid has been experienced, the knowledge that success is possible has been learnt. Any change to the person's need thereafter does not act independently of that prior experience but as a result of it along with many other factors personal to that consumer's life and experience. The psychosocial need for untreated versus treated hearing loss is and should be addressed differently. ⁴¹ Analysis of clinic appointments has shown that it is the psychosocial need that dominates consumer's concerns, often not getting effectively addressed causing consumers to re-raise the same issues at consequent appointments. ⁴² Further to this, it is then fitting that it is then fitting that the factors consumers felt were needed for success were predominantly psychosocial and non-auditory in nature. ²⁹

Addressing the unmet need of consumers may now see a new phase of innovation. The uncoupling of the sales channel for providing hearing aids, from the service model (i.e., the purchase from the care), is one opportunity for meeting previously unmet need. A double-blind trial looking at the access to hearing aids and the choice to adopt and adhere to hearing aids showed that when the same device could be accessed by OTC at the consumer's choice, over clinically provided, there were positive impacts on adoption and adherence. ²⁸ Given the severe challenge of low adoption and adherence with hearing aids, ^{13 14} utilizing innovation on hearing aid provision in combination with more targeted support for the individual psychosocial need of the consumer ⁴³ is one strategy now possible with more potential to succeed where failure has traditionally happened before. For hearing care providers, the hearing aids are the tool of trade; however, our value and expertise as care providers reaches far beyond the devices we use. Expansion of the tools now available to us and innovation in how we can deliver our care are opportunities rather than threats to our care penetrating further and more effectively than we have been able to before.

Meeting Marc's Need

The main challenges for Marc in his current position will be to minimize the disruption to his day and effort required on his part while assuring he has access to support equally that the clinician has access to him upon his request that may be key to preventing him giving up out of preventable impatience. Marc may have some confidence but clearly has less willingness to invest time and effort. A hearing care plan for Marc will need to be able to be adaptive to his initial behavior, maintaining a clinician can still assist him remotely to prevent disengagement.

Marc eventually opted for clinical technology in the form of hearing aids wanting more confidence in the audiological capability than he thought he may find from hearables, which were available to him directly by buying online, whereby he had access to support services designed for him to manage independently. This option is described as clinical technology, via consumer sales channel with consumer service (see Fig. 1 ).

Figure 1.

Marc and Marsha's final selection of hearing care provision according to a framework representation of provision options (with permission from Brice, Saunders and Edwards (2023) in this edition ¹ ).

Meeting Marsha's Need

The main challenges for Marsha and her current feelings will be to support a sense of being in control of the hearing aids such as having a diagnostic check function available, and a blended service model so she can work around her lifestyle when needed while aiming for clinical care when she can.

Marsha eventually opted for clinical technology in the form of hearing aids that were fitted and provided from her local clinic knowing that she could then maintain support with her clinician from her home. This option is described as clinical technology via consumer sales channel with hybrid services available (see Fig. 1 ).

CLINICAL CONSIDERATIONS THAT ENSURE OPTIMAL, PERSON-CENTERED OUTCOMES

Outcome measurements in audiology broadly aim to either verify or validate the impact of an intervention on a consumers need. The COSI ²⁰ and GHABP, ²¹ along with many other surveys, seek consumers' perspectives in deciding what hearing outcomes they wish to achieve along with their perceptions on the extent to which these have been achieved. A limitation of these instruments is that they may focus on goals that define the success of the hearing device in meeting its' performance objective rather than considering what the consumers' perspective of success might really be. Given the recognition that personal, psychosocial, and non-auditory needs have more influence on consumers' evaluation of success, reframing the outcomes away from device-dependent outcomes, such as the COSI and GHABP do, toward a more holistic view may allow us to identify and address consumers' true need more effectively. For example, success at a dinner party with hearing aids can be the ability to hear a particular person from a minimum distance; however, this description is focused solely on the performance of the device. When we reframe this objective to be the ability to feel comfortable and confident at the dinner party, the personal need for confidence rather than their objective competence in the situation can be better understood as the core need. Self-efficacy is the term applied to “confidence in the ability to exert control over one's own motivation, behavior, and social environment.” ⁴⁴ Person-centered care in audiology has been recognized as being dependent on supporting self-efficacy as part of effective long-term management of hearing loss. ⁴⁵ A person-centered, and hopefully more productive, perspective of the need a consumer may have at the typical dinner party scenario, where personalized motivation, behavior, and the impact of the social environment are recognized, may then be reframed to the following alternatives:

• Hearing from a minimum distance.

• Auditory coaching for listening skills.

• Stress management to reduce anxiety or feeling overwhelmed.

• Simply attending, addressing a personal fear of missing out.

• Being present with no interest to converse beyond a given person they choose to attend with.

• Attending an event independently of a significant other.

• Confidence that they have access to hearing care support, in situ, or via logging data.

The variations of possible outcomes from the same event of attending a dinner party take into account a wide range of non-auditory aspects of the experience. The mismatch between objective auditory performance dependent defined needs and the person-centered alternatives that may better suit the consumer may well be likely reasons for low adherence we have seen. If that is the case, innovation in hearing care provision may now be in a better position to succeed, or equip the industry with more choices to better suit and work with the need at hand. The recent development of a person-centered core outcome domain set to assist self-reported hearing rehabilitation assessment demonstrates innovation in defining and understanding need. ⁴⁶ Shifting the focus of what outcome should be considered, a holistic understanding of the need can be achieved. While this is only one example, it is promising to see a shift away from device-dependent concepts.

Person-Centered Need

Consumers of hearing care can seek more information than ever, shaping their ability to gain confidence, or confusion, in understanding their own need for hearing care. Bennett et al found clear relationships between different feature sets to address different consumer need. ¹⁰ Personalizing hearing care delivery may begin with what consumers express they want at the outset of their interaction, but their need will always be of greater clinical importance to the professional. Clarity, information from both sides, and a truly person-centered approach to hearing care is required to define and agree on what consumers require.

Person-centered care is widely accepted as a necessary standard way of providing hearing care to ensure quality of care and optimal outcomes. ⁴⁷ The origin of this, however, is equally important to understand not just why but also how we can proceed to achieve this. Carl Rogers coined the term “person-centered” in his psychology practice when challenged by the need for consumers to change behavior to find benefit from their treatment. ⁴⁸ The realization from Carl Roger's was of the importance of the consumer's behavior, while acknowledging their active choice in any action taken is central to the care that follows. A medical appreciation of person-centered care was later delivered by Wagner et al ⁴⁹ as well as Clark and colleagues ⁵⁰ in the 1990s, who found that active involvement of the person and providing a degree of autonomy in care planning and delivery for chronic illness did lead to improved clinical health outcomes. A chronic condition, in this case hearing loss, is profoundly influenced by ongoing behaviors and choices as the condition's management becomes a permanent part of the person's life. The decision to seek and wear a hearing aid is a behavior that only the consumer can perform. As a simple principle of aging biology, the decision not to wear a hearing aid is the single most important factor in further progression of hearing loss, and use of a hearing aid in retaining speech perception capability as a product of time. ³² As a result, hearing care professionals rely on consumers to encourage them to make the necessary behavioral changes for their personal and audiological need. Person-centered care is realized in hearing care as a product of a relationship between the person and the clinician, enforcing the core principles established by the seminal leaders of the field. ⁵¹ The best chance of achieving clinical and personal outcomes together is for hearing care professionals to develop skills in delivering a truly person-centered understanding of supporting the consumers in addressing their need as the expert of their own experience.

Clinical Impacts

In the published Competency Standards, Audiology Australia, the Australian peak body for audiologists refers to collaborative decision making, the need to be “client” focused and led wherever possible. ¹⁶ The growing availability of teleaudiology-based services made possible by hearing device manufacturers incorporating functionality into their products and supporting software has been a positive addition to modern audiological care. In Australia, there are now specific guidelines for teleaudiology, ⁵² supported by a wealth of evidence validating teleaudiology practices, ⁵ improved outcomes, ⁴ and person-centered teleaudiological care. ² The clinician's expertise will always be valuable in addressing the auditory need of the consumer. The clinician is the expert of the intervention implementation (i.e., ensuring the hearing aid provides the optimal benefit). However, in practice, clinical need cannot be met without taking into account the consumer's remaining need. In other words, the modern hearing care professional assists in the selection of appropriate service and channel for the consumer's holistic need, and within that framework, the clinician applies their expertise in assisting in the selection of technology to support the consumer's auditory need.

SUMMARY

Modern audiological care should be person-centered, responsive to the need of the consumer, and provided as part of a collaborative relationship. The tools of the trade are changing faster than ever before, making it more important than ever to have a clear understanding of the consumer's need and potential outcome. Learning how to capitalize on advances in audiological care can and should aid in a better understanding of how consumers' need may shift as their options change.

As a result of the increased availability of strategies, processes, and tools that assist consumers in achieving their best hearing care outcomes, an existing opportunity for hearing healthcare professionals exists. Simply put, the use of technology, clinical and nonclinical channels, and new services expands rather than contracts the role and ability of hearing healthcare professionals to serve consumers. Implementing strategies that allow a clinician to work with, for, and from a distance with consumers ensures that consumers will continue to approach hearing healthcare in the way that works best for them.