Pryce, Helen, Hall, Amanda, Marks, Elizabeth, Culhane, Beth-Anne, Swift, Sarah, Straus, Jean and Shaw, Rachel L (2018). Shared decision-making in tinnitus care - An exploration of clinical encounters. British Journal of Health Psychology, 23 (3), pp. 630-645.
Abstract
OBJECTIVES: This study examined clinical encounters between clinicians and patients to determine current practice for the diagnosis and treatment of tinnitus. The objective was to develop an understanding of the ideal clinical encounter that would facilitate genuine shared decision-making. DESIGN: Video ethnography was used to examine clinical encounters for the diagnosis and treatment of tinnitus. METHODS: Clinical encounters were video-recorded. Patients were interviewed individually following their clinic appointment. Data were analysed using constant comparison techniques from Grounded Theory. Initial inductive analyses were then considered against theoretical conceptualizations of the clinician-patient relationship and of the clinical encounter. RESULTS: Alignment between clinician and patient was found to be essential to a collaborative consultation and to shared decision-making. Clinician groups demonstrated variation in behaviour in the encounter; some asked closed questions and directed the majority of the consultation; others asked open questions and allowed patients to lead the consultation. CONCLUSIONS: A shift away from aetiology and physiological tests is needed so that tinnitus is managed as a persistent unexplained set of symptoms. This uncertainty is challenging for the medical professionals; lessons could be learned from the use of therapeutic skills. Further research is required to test techniques, such as the use of decision aids, to determine how we might create the ideal clinical encounter. Statement of contribution What is already known on this subject? Tinnitus is a condition in which sound is heard in the absence of an external source. Current approaches to managing tinnitus vary depending on clinical site (Hoare & Hall, ). In most instances, tinnitus does not have a straightforward medical cause. Tinnitus care is challenging to traditional biomedical encounters because the process of diagnosis may not lead to a defined treatment. Clinicians are required to consider not only what the tinnitus sounds like but more importantly, what it means for the affected individual. This requires a careful and skilled approach to eliciting a patient's current behaviour, coping, and preferences for both outcomes and treatment approaches. What does this study add? We provide the first in-depth description of decision-making in clinical services for tinnitus. Findings suggest a shift in focus is required to move away from the current prioritization of the biomedical treatment of tinnitus. There is variation to the extent different clinicians were able to deal with the uncertainty presented by the symptoms of tinnitus.
Publication DOI: | https://doi.org/10.1111/bjhp.12308 |
---|---|
Divisions: | College of Health & Life Sciences College of Health & Life Sciences > School of Psychology College of Health & Life Sciences > Chronic and Communicable Conditions |
Additional Information: | © 2018 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Funding: British Tinnitus Association. |
Uncontrolled Keywords: | tinnitus; hearing therapy; shared decision-making; concordance; lifeworld |
Publication ISSN: | 2044-8287 |
Last Modified: | 03 Oct 2024 07:16 |
Date Deposited: | 28 Feb 2018 14:00 |
Full Text Link: | |
Related URLs: |
https://bpspsyc ... ournal/20448287
(Publisher URL) |
PURE Output Type: | Article |
Published Date: | 2018-09-01 |
Published Online Date: | 2018-03-25 |
Accepted Date: | 2018-02-26 |
Authors: |
Pryce, Helen
(
0000-0001-5183-6236)
Hall, Amanda ( 0000-0001-8520-6005) Marks, Elizabeth Culhane, Beth-Anne Swift, Sarah Straus, Jean Shaw, Rachel L ( 0000-0002-0438-7666) |
Download
Version: Published Version
License: Creative Commons Attribution Non-commercial No Derivatives
| PreviewVersion: Accepted Version
Access Restriction: Restricted to Repository staff only