Margol-Gromada, Magdalena, Cullington, Helen and Kitterick, Padraig (2019) Getting ready for cochlear implant assessment using online tools at home. When studies do not go to plan, and what we can learn. British Cochlear Implant Group Meeting 2019: Connecting for Life, Solent Conference Centre, Southampton, United Kingdom. 04 - 05 Apr 2019.
Abstract
Aim: An important part of cochlear implant assessment is the ‘communications’ appointment, where the patient’s motivations, expectations and needs are gathered and evaluated by a clinician. Assessment can be a stressful and busy time for the patient, and they may be unable to make full use of the session. Using online tools or apps before an appointment increases preparation for and engagement in appointments (Frost et al., 2013; Ashurst et al., 2014). We proposed that by beginning this thought process at home, the clinical appointment would be more patient-centred - focussing on exploring specific needs, rather than being an information-gathering exercise. We aimed to trial Ida Institute tools ‘Living Well Online’ and ‘My Turn to Talk’ (Ida Institute, 2017) in adults referred for cochlear implant assessment using a two-arm Randomised Controlled Trial.
Method: Inclusion criteria were:adults ability to give informed consent sufficient English to understand and complete study documentation and online tools access to the internet referred for cochlear implant assessment at the University of Southampton Auditory Implant Service Participants were randomised to either the control group (standard pathway) or the intervention group (using online tools). Participants in the intervention group were asked to use the tools at any time before their appointment. The communications appointment was video recorded for both groups, and patients completed a satisfaction questionnaire. We wanted to compare the appointments in terms of turn-taking, patient-centredness, nature of conversation, number of interactions, balance of patient/clinician talking-time, and balance of identifying communication needs versus further exploration of needs. We also wanted to examine empowerment, using a modified pre-implantation version of the CI-EMP questionnaire (Cochlear Implant Empowerment) (Kitterick, Fackrell, & Cullington, 2016) at baseline and after the appointment.
Results: The trial was closed before 30 participants was achieved. Only eight participants were recruited over 7 months, although the usual referral rate of around 15 patients per month remained. Possible reasons were: · Advertisement method - mailed to patients with a plethora of other information · People following a ‘borderline’ pathway may not have felt engaged with research as they were yet to find out whether they were eligible for cochlear implantation · Emotional intensity of assessment period · Patient discharge rates before attending clinic Even those who agreed to participate did not provide full data due to not telling us in time that they wanted to take part so were unable to use tools before appointment, or they misunderstood the use of the tools. One patient explained that he had been an engineer all his life and he thought of something completely different when he read the word ‘tools’.
Conclusion: We strongly believe in reporting negative study results, in the interest of learning, non replication of future studies, and avoiding publication bias. We are keen to continue to explore the utility of online tools in the assessment phase of the cochlear implant journey, and will consider engaging patients and candidates for implantation to co-design recruitment material and inform study design. Reference (If applicable)Frost, J., Anderson, R., Argyle, C., Daly, M., Harris-Golesworthy, F., Harris, J., et al. (2013). A pilot randomised controlled trial of a preconsultation web-based intervention to improve the care quality and clinical outcomes of diabetes outpatients (DIAT). BMJ Open, 3(7).Ashurst, E. J., Jones, R. B., Abraham, C., Jenner, M., Boddy, K., Besser, R. E., et al. (2014). The diabetes app challenge: user-led development and piloting of internet applications enabling young people with diabetes to set the focus for their diabetes consultations. Med 2 0, 3(2), e5.Kitterick, P. T., Fackrell, K., & Cullington, H. E. (2016). Measuring empowerment in adult cochlear implant users - The development of the CI-EMP questionnaire [poster]. Paper presented at the British Cochlear Implant Group Meeting. Ida Institute. (2017). Ida Telecare http://idainstitute.com/toolbox/telecare/prepare_for_your_first_appointment/. Retrieved March 3, 2016, from http://idainstitute.com/toolbox/telecare/prepare_for_your_first_appointment/
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