Enhancing the COSI goal-setting discussion

Project goals and methodology

Audiological practice worldwide has radically changed over the past several decades, driven by advancements in technology, research, and changing client needs and expectations. Accordingly, the basic procedure outlined in the original Client Oriented Scale of Improvement (COSI) publications may not reflect the pattern of use currently implemented in Audiological clinical practice 27 years post publication. While the COSI is still widely used, audiologists have likely developed their own methods and approaches to using the tool based on their clinical experience and from the changing needs of their clients. Building on the evidence-based research and insights on contemporary Audiological practice, an evaluation and development of COSI is warranted to ensure that the hearing goal setting tool continues to meet the needs of audiologists and their clients in an ever-evolving field.

A team at NAL deep dived into the current implementation of the COSI and highlighted where opportunities exist to improve hearing goal setting practice. This project took a dual-pronged approach, with retrospective analysis of over one million COSI goals as well as in-depth interviews with clinicians about their use of the COSI with their clients in the clinic.

Key findings

The project identified a number of key insights about the current use of COSI for goal setting, including the fact that the client’s role in setting, attempting and achieving their goals is not well defined. Clinicians also reported that a particular pain point is the lack of tools to help clients identify suitable listening goals. The results of this project highlighted areas in the current COSI Goal Setting procedure that should be updated to enhance the client experience and bring the process more in line with the rehabilitation goal setting literature and best practice. The research team has adapted these insights into a new COSI goal setting framework (see below). Elements of this updated COSI framework will be tested with clinicians and clients to inform updated tools and procedures to aid the effective use of goal setting in audiological rehabilitation.
The eventual aim is to release the updated COSI tool and procedure that is more in line with rehabilitation goal setting best practice and client centred care.