Improving Adult Access to Cochlear Implants: Understanding and Facilitating Informed Decision-making

Project rationale

Individuals with severe and profound hearing loss stand to gain significant benefits from cochlear implants (CIs). While approximately 9 out of 10 children who could benefit from a CI receive one, the statistics for adults are strikingly low, with less than 1 in 10 adults accessing this technology.

For adults to have access to cochlear implants, they must first be informed about them and have the opportunity to understand how they could potentially offer greater benefits compared to their current hearing aids. Hearing health professionals who assist adults with hearing aids play a crucial role in this process by initiating discussions about cochlear implants and referring for a CI assessment. During this assessment, a specialized team evaluates whether a CI is the appropriate choice for the individual.

Unfortunately, many adults remain unaware of the potential benefits of cochlear implants and do not undergo a CI assessment, thereby missing out on a potentially life-changing opportunity.

Project goals and methodology

The project team spoke to the clinical professionals who manage the hearing of adults who use hearing aids and who might benefit from CI. The project found that these clinicians often only discuss CI with their adult clients and send them for a CI assessment when they are very sure that their client will want them or is very likely to benefit from them. The downside of this approach is that it is the clinician and not the individual with the hearing loss who is deciding who should find out about CIs and when they should have the opportunity to find out more about them. This responsibility can place a lot of pressure on clinicians when deciding what constitutes ‘good’ referral practices.

Subsequently a series of clinician and client facing tools were developed and tested with representatives of their respective target audiences. Feedback from these tools were collated and assessed for the potential value for clinicians and clients alike.

Key findings

This project uncovered certain factors that contribute to clinicians’ hesitation to discuss a CI with their clients, as well as challenges for adult clients when considering a CI as an option for their hearing needs. For both groups, identified barriers were considered in relation to how unconscious cognitive biases may be making CI decisions more difficult – and how these could be addressed to better support conversations. The findings of this project hold potential for reshaping the beliefs held by both clinicians and clients and supporting decision-making regarding CIs.  

Participants’ responses to the clinician-facing tools reiterated the value placed on strengthening relationships between hearing aid and cochlear implant clinics.  Clinicians were highly supporting of the potential for tools to provide increased and more transparent communication between themselves and CI clinics – particularly where this could minimise the reliance on the clients to be the keepers/conveyers of information– a role that they may be poorly qualified to undertake.   

The study ultimately concluded that clinicians would have more confidence to broach the subject of CI with their clients if they felt adequately equipped to support them through the process of learning about CIs and undergoing a CI assessment. Results of this work shows support needs to go further than simply ‘information’ provision.  Understanding the cognitive biases that may drive and sustain common misconceptions or ‘FAQ’s could be a valuable key to helping address them.

Similarly, clients would feel more comfortable to explore CIs as an option for themselves when they can learn from individuals ‘like them’ who have undergone the experience. This may be done by providing examples of people and experiences that clients identify with, to help normalise the experience of CI exploration for potential candidates.

Acknowledging clinicians’ desire for greater collaboration is likely to be a useful gateway to engaging them with CI referral strategies. Facilitating this feeling of greater teamwork can provide opportunities beyond just the increased connection between clinics and clinicians. Strategies that offer opportunities to facilitate better collaboration between clinics are more likely to be embraced by clinicians, thereby creating opportunities for ongoing skill development and engagement. 

Conclusion

Ultimately, disseminating the insights gained from this project could significantly increase the likelihood that more adults are informed about, and open to, exploring a CI as a standard aspect of their ongoing hearing care. This, in turn, would empower them to make informed decisions about all of their hearing rehabilitation options.