Researchers at Aston University Aid Decision Making Process
Three studies were undertaken to enable shared decision making in tinnitus care
Shared decision making means that when more than one possible treatment exists, patient values and preferences should determine which treatment is used. This decision making process is particularly relevant for conditions such as Tinnitus.
Tinnitus is a condition in which sufferers hear noises (ringing or buzzing) not caused by an external source. It is a chronic condition that is without medial cure in most cases. Traditionally, treating tinnitus has been determined mostly by clinician’s preferences. More research and understanding into patients’ needs is required to improve shared decision making for patients suffering with tinnitus.
Dr Helen Pryce is Senior Lecturer in Audiology at Aston University. Her research explores the psychosocial influences of chronic hearing conditions from individual level responses to institutional and cultural influences on hearing services. She is a member of the British Academy of Audiology and British Society of Audiology with an aim to support shared decision making in hearing care.
Joined by a small team of researchers at Aston, Dr Pryce sought to improve tinnitus treatment and care for patients through research in shared decision making.
The research in this project was a first of its kind exploring patient values and preferences for care in tinnitus. The research was also the first to detail the nature of current patient interactions with clinicians.
Three studies were undertaken to enable shared decision making in tinnitus care. Through the studies, patient information needs, values and preferences for care were highlighted. Through the second study, current patterns of clinical interaction and decision making were identified.As a result, a decision aid was developed in collaboration with a group of clinicians, researchers and tinnitus patients.
At first, the drafted decision aid was shared with wider groups of experts in tinnitus for comment and revision. Finally, through collaboration with British Tinnitus Association, the decision aid was formatted and published on their website, launching at their conference in 2017.
During the studies, a range of qualitative methods were used to explore participant views and current practices. This included focus groups, in depth interviews, video ethnography, readability, software testing and usability testing. This data was gathered in local tinnitus care services in a range of settings in urban, suburban and rural areas such as London, Somerset and Bath.
Once the aid and resources were developed, Dr Pryce travelled to clinical sites and attended team meetings to describe the decision aid and inform clinicians on how it could be used. Ongoing training is still given to local care providers.
Articles written during the project were published in both academic and professional journals in the UK and USA and Dr Pryce recorded podcasts and contributed to European guidelines for tinnitus care.
As a result of this project, the decision aid was taken up in clinical practice in the UK and beyond. Use of the decision aid resulted in raised awareness and understanding of care options for tinnitus through additional knowledge for service providers and patients. This has successfully led to a measured reduction of decisional conflict for patients with tinnitus.
The project has led to the inclusion of shared decision making as a recommendation in European guidelines for tinnitus care. The decision aid is also now within the taught curricula for audiology and otology professionals across the world.
This has greatly impacted the lives of those suffering with tinnitus. For the first time, in accessible language, there is a simple document highlighting the pros and cons of different treatments. This makes it easier for patients to make informed decisions and engage in better conversations with their clinicians.
Decision aids improve health literacy and reduce decisional conflict by ensuring that a patient’s choice of treatment is more likely to be in line with their values and preferences. For example, for every 6-7 people given the decision aid, 1 additional person will have no decisional conflict at all.
The research has had global impact as the decision aid was picked up and recommended by Canadian training courses and has been referenced in Canadian textbooks. The information has also reached American, Australian, Danish and Brazilian clinicians through a podcast and curricula amendment.
Furthermore, the research has been acknowledged by the British Society of Audiology who awarded the Thomas Simm prize for contribution to academic audiology.
It is estimated that approximately six million people in the UK suffer with tinnitus (British Tinnitus Association, 2018). Considering this statistic, it is clear that greater support is needed for those living with this chronic hearing difficulty. Improved information, treatment and decision making regarding tinnitus will do more to help patients with the condition.