Parental decision-making in considering cochlear implant technology for a deaf child

Incorporating Parents' Lived Experiences Into the Pediatric Audiology Course: A Qualitative Analysis of Student Reflections

PURPOSE

This study explores the underutilized pedagogical approach of incorporating lived experiences of parents with children possessing diverse hearing profiles and their family characteristics into the audiology curriculum for students. The aim was to investigate the impact of integrating such experiences into the classroom as an andragogical learning experience through the qualitative analysis of written student reflections.

METHOD

Twelve (N = 12) third-year female audiology students enrolled in a pediatric auditory (re)habilitation course attended a parent panel presentation during their regularly scheduled face-to-face class. Five parents of children with diverse hearing differences and diverse technology, communication, and educational choices participated on the panel as guest speakers via the Zoom platform. Students completed written reflections based on Rolfe's reflective framework. Written reflections were downloaded from Canvas and de-identified prior to uploading to NVivo software for coding, utilizing an inductive grounded theory coding strategy coupled with content analysis.

FINDINGS

This study underscores the effectiveness of written reflections as an effective andragogical learning model. Through reflective practice, students gained a deeper understanding of their experiences, values, and learning journeys, enhancing their competency in pediatric audiology and auditory (re)habilitation. Students articulated previous knowledge and learning experiences, utilized newfound insights from exposure to the parent panel of shared lived experiences, and connected this knowledge with future clinical applications.

CONCLUSIONS

Key findings underscore the effectiveness of reflective practice as an andragogical learning model, facilitating the integration of prior experiences with new knowledge. Moreover, it aids the transition of the professional journey from the familiar to the unfamiliar, demonstrating the impact of combining real-world lived experiences to reinforce and highlight classroom topics. Additionally, reflective practice enhances professional efficacy by valuing patient/parent perspectives regarding clinical care and aligning with evidence-based principles.

Benefits and risks related to cochlear implantation for children with residual hearing: a systematic review

OBJECTIVE

This study aimed to synthesise information concerning the potential benefits and risks related to cochlear implants (CIs) versus hearing aids (HAs) in children with residual hearing.

DESIGN

A systematic review of articles published from January 2003 to January 2019 was conducted.

STUDY SAMPLE

Our review included studies that compared the benefits and risks of CIs versus HAs in children (≤18 years old) with residual hearing. A total of 3265 citations were identified; 8 studies met inclusion criteria.

RESULTS

Children with CIs showed significantly better speech perception scores post-CI than pre-CI. There was limited evidence related to improvement in everyday auditory performance, and the results showed non-significant improvement in speech intelligibility. One study on social-emotional functioning suggested benefits from CIs. In four studies, 37.2% (16/43) of children showed loss of residual hearing and 14.0% (8/57) had discontinued or limited use of their device.

CONCLUSIONS

Children with CIs showed improvement in speech perception outcomes compared to those with HAs. However, due to the limited number of studies and information to guide decision-making related to other areas of development, it will be important to conduct further research of both benefits and risks of CIs in this specific population to facilitate decision-making.

Hearing parents learning American Sign Language with their deaf children: a mixed-methods survey

Hearing parents with deaf children face difficult decisions about what language(s) to use with their child. Sign languages such as American Sign Language (ASL) are fully accessible to deaf children, yet most hearing parents are not proficient in ASL prior to having a deaf child. Parents are often discouraged from learning ASL based in part on an assumption that it will be too difficult, yet there is little evidence supporting this claim. In this mixed-methods study, we surveyed hearing parents of deaf children (n = 100) who had learned ASL to learn more about their experiences. In their survey responses, parents identified a range of resources that supported their ASL learning as well as frequent barriers. Parents identified strongly with belief statements indicating the importance of ASL and affirmed that learning ASL is attainable for hearing parents. We discuss the implications of this study for parents who are considering ASL as a language choice and for the professionals who guide them.

Evaluation of Parental Perspectives and Concerns about Pediatric Cochlear Implantation: A Social Media Analysis

OBJECTIVE

Parents often experience uncertainty during decision-making for their child's cochlear implantation (CI) surgery, and online forums provide insight on parental opinions that might not be expressed in clinic. This study aims to evaluate parental perspectives and concerns about pediatric CI using social media analysis.

STUDY DESIGN

Qualitative study.

SETTING

Three online forums involving parental posts about pediatric CI.

INTERVENTION/METHODS

Forums were queried using keywords (e.g., "cochlear implant") to gather all U.S. parent-initiated posts about pediatric CI from 2006 to 2021. Thematic content analysis was performed to classify posts by overarching domain, themes, and subthemes. Posts were reviewed for thematic synthesis and double coded. Descriptive statistics were calculated for each theme by unique users.

RESULTS

A total of 79 posts by 41 unique users were analyzed. Themes relating to decision for CI included facilitators, inhibitors, resources, and feelings. Parents posted about lack of benefit from hearing aids promoting decision for CI and high cost as an inhibitor. Some expressed concern about making a major decision for a minor. Parents often mentioned their child's healthcare providers and social media as resources.

CONCLUSION

Through social media posts, parental priorities and concerns for decision-making of CI surgery were identified. Findings may guide discussions between physicians and parents and facilitate shared decision-making about CI.

Cochlear implant decision-making for children with residual hearing: Perspectives of parents

PURPOSE

Cochlear implant (CI) decision-making is particularly challenging for families of children who have residual hearing. Parents of these children may be uncertain about whether the potential benefits of CIs outweigh the risks. This study aimed to understand parents' decisional needs during the decision-making process for children with residual hearing.

METHOD

Semi-structured interviews were conducted with parents of 11 children who had received CIs. Open-ended questions were asked to encourage parents to share their experiences about the decision-making process, their values/preferences, and their needs. The interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Data were organized according to three key themes: (1) Parents' decisional conflict, (2) values and preferences, (3) decision support and parents' needs. We found that overall parents were satisfied with their decision-making process and the decision support from practitioners. However, parents stressed the importance of receiving more personalized information that considers their specific concerns, values and preferences related to family's circumstances.

CONCLUSIONS

Our research provides additional evidence to guide the CI decision-making process for children with residual hearing. Additional collaborative research with audiology and decision-making experts specifically on facilitating shared decision-making is needed to provide better decision coaching for these families.

Exploring patient experiences and concerns in the online Cochlear implant community: A cross-sectional study and validation of automated topic modelling

OBJECTIVE

There is a paucity of research examining patient experiences of cochlear implants. We sought to use natural language processing methods to explore patient experiences and concerns in the online cochlear implant (CI) community.

MATERIALS AND METHODS

Cross-sectional study of posts on the online Reddit r/CochlearImplants forum from 1 March 2015 to 11 November 2021. Natural language processing using the BERTopic automated topic modelling technique was employed to cluster posts into semantically similar topics. Topic categorisation was manually validated by two independent reviewers and Cohen's kappa calculated to determine inter-rater reliability between machine vs human and human vs human categorisation.

RESULTS

We retrieved 987 posts from 588 unique Reddit users on the r/CochlearImplants forum. Posts were initially categorised by BERTopic into 16 different Topics, which were increased to 23 Topics following manual inspection. The most popular topics related to CI connectivity (n = 112), adults considering getting a CI (n = 107), surgery-related posts (n = 89) and day-to-day living with a CI (n = 85). Cohen's kappa among all posts was 0.62 (machine vs. human) and 0.72 (human vs. human), and among categorised posts was 0.85 (machine vs. human) and 0.84 (human vs. human).

CONCLUSIONS

This cross-sectional study of social media discussions among the online cochlear implant community identified common attitudes, experiences and concerns of patients living with, or seeking, a cochlear implant. Our validation of natural language processing methods to categorise topics shows that automated analysis of similar Otolaryngology-related content is a viable and accurate alternative to manual qualitative approaches.

A comparison of the quality of life of parents of children using hearing aids and those using cochlear implants

Objective

The goal of this study was to evaluate the quality of life of parents of children who use hearing aids (HA) with those who use cochlear implants (CI) in the Indian context and document any differences found.

Methods

The Kannada version of the AQoL-4D was administered in a modified fashion to 131 parents (87 HA and 44 CI). Sociodemographic details were collected for supplemental information on the intervention strategy used.

Results

A total of 49 parents (29 HA and 20 CI) responded to the questionnaire sent. The mean total scores for both the groups were similar (HA group = 17.9 (SD = 5.5), CI group = 17.2 (SD = 3.4)), as was the score for the first subscale (HA group = 8.6 (SD = 2.9); CI group = 8.5 (SD = 2.6)) of the AQoL-4D. No significant differences were found between the two groups on either scores [Total Score: U (NHA = 29, NCI = 20) = 280.5, z = -0.194, p > 0.05; Subscale 1 Score: U (NHA = 29, NCI = 20) = 281.5, z = -0.176, p > 0.05]. The degree of hearing loss in the hearing aid group was equivalent to that of the cochlear implant group but this did not appear to influence parental quality of life.

Conclusion

Parents of children with hearing aids and cochlear implants appear to be similar on several psychosocial factors in the realms of functional, social, and psychological well-being. In terms of parental quality of life, hearing aids and cochlear implants appear to be equally effective intervention techniques.

Research About Parents of Children with Cochlear Implants: A Scoping Review

Parents of children who are deaf or hard of hearing have long attracted interest from researchers, though, since the 1990s, published research about this population has increasingly gravitated toward issues surrounding pediatric cochlear implantation. This scoping review was undertaken to map the nature, extent, and range of three decades of research about parents of children with cochlear implants, and reports on (1) publication characteristics, (2) sampling characteristics, and (3) study design characteristics within 80 peer-reviewed articles published between 1990 and 2020. The results indicate several gaps and gluts within the field, including a lack of diversity within (and detail about) study samples, a disproportionate focus on evaluating parents' personal characteristics and (presupposed) psycho-emotional problems, and a scarcity of participatory or co-constructed projects. The results may inform future research, ensuring a wider range of perspectives and experiences are recorded and issues of highest priority and relevance to families are investigated.

Patient, parental and multi-disciplinary team rationale for non-implantation following the paediatric cochlear implantation assessment

OBJECTIVES

To assess paediatric patients referred to the cochlear implant team, who despite undergoing the assessment, did not receive cochlear implantation. To identify the underlying reasons for this.

METHODS

A retrospective case-note review of patients was assessed from June 2014 to June 2019 at two separate London teaching hospitals with paediatric cochlear implantation programmes.

RESULTS

A total of 921 paediatric patients were assessed during the study period across both institutions. And, 196 (21%) did not proceed with the surgery. The decision not to undergo surgery was primarily parental/patient-directed in 114 (61%) and cochlear implant team-directed in 74 (39%). In total, eight (4%) patients exited the programme without a documented reason.

DISCUSSION

A myriad of factors influenced the decision-making process for clinicians, patients and parents. The most cited parental/patient rationale against implantation was the wish to continue current means of communication 40 (35%), followed by concern regarding the risks of surgery 18 (15.8%) and the wish to allow the patient to make future decisions independently in view of the future technology 7 (6.1%). Cochlear implant team-directed decisions were largely due to being outside of the NICE criteria 27 (36.5%) or the risks of general anaesthesia 19 (25.7%) in addition to communication concerns 11 (14.9%).

CONCLUSION

Decision-making in cochlear implantation should not be underestimated. Extensive discussion and exploration of options with the multi-disciplinary team can aid decision-making, but the timescale and appreciation of the consequences of the decision inevitably lead to pressure. Exploration of reasons for non-implantation emphasises the importance of a multi-professional approach to manage these patients.

Identification of Potential Barriers to Timely Access to Pediatric Hearing Aids

Importance

Despite various barriers identified to early pediatric access to cochlear implantation, barriers to timely access to pediatric hearing aids are not well characterized.

Objective

To identify socioeconomic, demographic, and clinical factors that may be associated with pediatric access to hearing aids.

Design, Setting, and Participants

This retrospective cohort study included 90 patients aged 1 to 15 years who were referred for auditory brainstem response (ABR) testing and evaluation for hearing aids at a single tertiary care academic medical center from March 2004 to July 2018. Children who did not receive both ABR testing and hearing aids at the same center were excluded from analysis.

Main Outcomes and Measures

Associations of insurance type (private vs public), race/ethnicity (white vs other), primary language (English vs other), cause of hearing loss (complex vs not complex), zip code, hearing aid manufacturer, and severity of hearing loss (in decibels) with the duration of intervals from newborn hearing screening to ABR testing, from ABR testing to ordering of hearing aids, and from ABR testing to dispensing of hearing aids.

Results

Of the 90 patients, mean (SD) age was 5.6 (3.7) years, 56% were female, and 77 (86%) were non-Hispanic. Results of χ2 tests indicated significant assocations existed between public insurance and race/ethnicity and between public insurance and primary language other than English. Variables associated with the interval from newborn hearing screening to ABR testing included insurance type (mean difference, 7.4 months; 95% CI, 2.6-12.2 months) and race/ethnicity (mean difference, 6.9 months; 95% CI, 2.7-11.1 months). Increased delays between birth and a child's first ABR test were associated with public insurance (mean difference, 6.0 months; 95% CI, 1.8-10.2 months) and race/ethnicity other than white (mean difference, 6.0 months; 95% CI, 2.3-9.7 months). The mean time from birth to initial ABR testing was a mean of 6 months longer for patients from non-English-speaking families than for those from English-speaking families (mean [SD] interval, 14.9 [16.3] months vs 9.0 [8.5] months), although the difference was not statistically significant. Severity of hearing loss was associated with a decrease in the interval from ABR testing to ordering of hearing aids after accounting for other potential barriers (odds ratio, 0.6; 95% CI, 0.4-0.9). Zip code and complexity of the child's medical condition did not appear to be associated with timely access to pediatric hearing aids.

Conclusions and Relevance

This study's findings suggest that insurance type, race/ethnicity, and primary language may be barriers associated with pediatric access to hearing aids, with the greatest difference observed in time to initial ABR testing. Clinical severity of hearing loss appeared to be associated with a significant decrease in time from ABR testing to ordering of hearing aids. Greater efforts to assist parents with ABR testing and coordination of follow-up may help improve access for other at-risk children.

Parent reported barriers and facilitators towards cochlear implantation - A systematic review

CONTEXT

Early identification and intervention of hearing loss at a young age leads to long term benefits from language, communication, social, educational and financial aspects. Cochlear implantation is a widely recommended rehabilitation option for hearing loss. The process of cochlear implantation is a long one and the role played by parents is crucial.

OBJECTIVE

The present systematic review was carried out with the aim of identifying the different parent reported barriers towards cochlear implantation.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Cochrane Library.

STUDY SELECTION

Studies in parent reported barriers towards cochlear implantation screened and identified using 3 stages by 2 reviewers. Mixed Methods Appraisal Tool was used to carry out the quality appraisal of included studies.

DATA EXTRACTION

Outcome measures related to barriers and facilitators.

RESULTS

Nineteen studies were identified and included in the present review which discussed the parent reported barriers based on themes such as service delivery, social issues, time related, device/surgery, financial, child related and others. The different factors that facilitated the process included availability of resources, finances, child related and parental.

CONCLUSION

The present review was a novel attempt at exploring the different parent reported barriers towards cochlear implantation. The facilitators, which can be used to overcome these barriers, will be useful for making the process smoother.

Exploring how parents of children with unilateral hearing loss make habilitation decisions: a qualitative study

OBJECTIVE

This study sought to explore the decision making needs of parents managing the hearing and communication needs of children with unilateral hearing loss.

DESIGN

An inductive, qualitative method was used. The data were analysed using a constant comparative approach, consistent with Grounded Theory method.

STUDY SAMPLE

Twenty one families participated in interviews yielding data on twenty two children. Each of these families had at least one child with unilateral hearing loss. The age range of the children varied from four months to sixteen years old. All parents were English speaking and received care from National Health Service Audiology departments across the United Kingdom.

RESULTS

Parents valued professionals' opinions, but information provision was inconsistent. As their children mature, parents increasingly valued their child's input. Parent-child discussions focussed on how different management strategies fit their child's preferences. Parents were proactive in obtaining professional advice, and integrating this with their own iterative assessment of their child's performance.

CONCLUSIONS

Decision making is an iterative process. Parents make nuanced decisions which aim to preserve a sense of what is normal for them. Clinicians need to recognise the parental view, including where it may contrast with a medicalised or clinical view.

Relationship Between Parental Stress and their Attitudes Towards Cochlear Implantation Outcomes in Children Referred to Besat Cochlear Implant Center in Hamadan 2018

PURPOSE

This study aimed to investigate the relationship between parental stress and their attitudes towards post-cochlear implantation outcomes in children referred to Besat cochlear implant center in Hamadan during 2018.

DESIGN AND METHODS

In this descriptive cross-sectional study, 100 parents of children with cochlear implantation were selected from Besat cochlear implant center in Hamadan through census method from April to October 2018. The data were collected using a demographic characteristic questionnaire, parental stress scale developed by Berry and Jones, and Parental Attitudes of Various Aspects of Cochlear Implantation. The data were analyzed using SPSS software (version 16) through correlation coefficient, one-way ANOVA, and t-test. P-value <0.05 was considered statistically significant.

RESULTS

The results of this study indicated that parental stress negatively correlated with their attitudes towards the outcomes of cochlear implantation (r = -0.420), including the aspects of communication (r = -0.462), educational (r = -0.398), and social skills (r = -0.445), as well as services provided by the health care centers (r = -0.277), and the efficiencies of cochlear implantation center (r = -0.118) (P < 0.05).

CONCLUSION

According to the results, parents with more positive attitudes towards the areas of communication, educational, and social skills, as well as services provided by the health care centers, and the efficiencies of cochlear implantation center experienced lower levels of stress.

PRACTICE IMPLICATIONS

Nurses can measure the stress and attitudes towards cochlear implantation outcomes in children to accurately assess the needs of the family in order to improve their nursing process and advance the child's rehabilitation program.

Mothers' emotional experiences related to their child's diagnosis of deafness and cochlear implant surgery: Parenting stress and child's language development

OBJECTIVES

The present study aims to assess the emotional experiences, specifically parenting stress, of mothers of children with cochlear implants (CIs), and their children's language development before surgery and at three and six months after CI activation.

METHODS

Twenty mothers of children with CIs were interviewed before their children's surgery about their experiences in connection with the diagnosis of deafness, the surgery and the activation of the CI. The Parenting Stress Index questionnaire and the MacArthur-Bates-Communication Development Inventory were administered before the surgery and at 3 and 6 months after the CI activation.

RESULTS

Analysis of the qualitative data resulting from the interviews showed that the mothers' emotional experiences before the CI surgery were complex. Mothers reported both positive and negative emotions related to deafness, diagnosis and surgery, benefits of the CI, coping strategies and future expectations. The mothers of children with more advanced lexical production six months after CI activation displayed a high frequency of themes related to positive emotions, thoughts and coping strategies before the surgery. Distress on the part of the mothers, perceptions of difficulties in their child and instances of parent-child dysfunctional interaction were negatively and significantly related to the child's language and communication development.

CONCLUSIONS

The findings support the importance of assessing the mother's emotional experience in relation to diagnosis and CI activation before the surgery. IMPLICATIONS FOR CLINICAL PRACTICE ARE DISCUSSED: specifically, the importance of the support offered to the parents, aimed at enhancing both their awareness of their expectations about their child's rehabilitation process and their self-efficacy in supporting the child's adaptation to the use of the CI.

What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

Objective: Our objective was to understand the factors that determine whether an adult who is eligible for cochlear implantation (CI) choose to take up or not take up the implant.Design: We conducted a qualitative in-depth interview study, informed by grounded theory methods of constant comparison to build a theory to describe why and how people decide to opt for CI or not.Study sample: Our samples were patients from an audiology service in England.Results: Our results describe the key factors in weighing up risks and benefits. These are influenced by living context and support, information and social identity. We identify the key features that impact decision making for adults eligible for cochlear implants. The importance of the patient lifeworld view is discussed.Conclusions: This qualitative study provides the first in depth examination of how and why patients do and do not take up the offer of cochlear implants. It highlights the complex and iterative nature of this decision making and the individualised risks that trade off benefits of implantation.

Maternal Perception of Self-Efficacy and Involvement in Young Children with Prelingual Hearing Loss

Appropriate intervention needs to support families and consider them as a part of rehabilitation program. Parents who have high self-efficacy are more likely to put their knowledge and skills into action and have positive interactions with their children. In addition, there has been a positive relation between parental involvement and child educational success. The aim of present study was evaluating maternal perception of both self-efficacy and involvement between mothers of children with hearing aid and cochlear implant via Scale of Parental Involvement and Self Efficacy (SPISE) and exploring relationship between maternal self-efficacy and parental involvement and child factors. 100 mothers of children with hearing loss were available. 49 mothers participated in study, filled SPISE, and return it on time. SPISE consisted of three sections (1) demographic information, (2) maternal self-efficacy, (3) parental involvement. All cases had received at least 6 months auditory training and speech therapy. Participants included 30 (61.2%) mothers of children with hearing aid, 19 (38.8%) mothers of children with cochlear implant. ANOVA analysis showed that there is no significant difference between hearing aid (HA) and cochlear implant (CI) groups in term of self-efficacy and parent-involvement except for question 21 (comfortable in participating in individualized program) that score in HA group was significantly higher than CI group. Results of present study has practical implications for early interventionists working with families. Every early intervention program should consider families to reach maximum outcome. Early interventionists can use SPISE to evaluate parental selfefficacy and involvement and work on parents with low score to achieve the best results.

Parental Decision-Making and Deaf Children: A Systematic Literature Review

Parents or caregivers of children who are deaf or hard of hearing are required to make complex and rational decisions soon after the confirmation of hearing loss. Ways of facilitating decision-making have been a focus within the healthcare sector for two decades and shared decision-making is now widely viewed as the standard for good clinical care. A systematic literature review was undertaken to identify the extent to which the principles of shared decision-making and informed choice have been implemented for parents when they make decisions related to their children with permanent hearing loss. Five databases were searched for peer-reviewed papers describing the results of original research published from 2000 to 2017, yielding 37 relevant papers. Studies were reviewed using the three phases of decision-making-information exchange, deliberation, and implementation. Two decisions dominated these studies-implantable devices and communication modality. Most papers dealt with decision-making in the context of bilateral hearing loss, with only one study focusing on unilateral hearing loss. The review identified gaps where further research is needed to ensure the lessons learnt in the broader decision-making literature are implemented when parents make decisions regarding their child who is deaf or hard of hearing.

Factors Influencing Caregiver Decision Making to Change the Communication Method of their Child with Hearing Loss

The communication journey of a child with hearing loss is often a complex, interwoven process in which the child's use of language or method of communication may change numerous times. As there has been limited research exploring the caregiver decision making process behind making such changes, this qualitative descriptive study aimed to explore the factors which influence the caregiver decision making process to change the communication method of their child with hearing loss. Individual semi-structured in-depth interviews were conducted with seven caregivers of children with hearing loss in Australia. Thematic analysis revealed five key themes which influenced caregiver decisions regarding changes to their child's method of communication, including: (1) family characteristics; (2) family access to information; (3) family strengths; (4) family beliefs; and (5) family-centered practice. The overall finding that the family unit is at the core of decision-making has important clinical implications regarding early intervention professionals' provision of family-centered services when working with the families of children with hearing loss.

Vocabulário expressivo em crianças usuárias de implante coclear

RESUMO Objetivo: verificar a aquisição de vocabulário em crianças surdas, usuárias de implante coclear, bem como os fatores que influenciam esse desenvolvimento. Métodos: foi aplicada a parte de vocabulário do teste de linguagem infantil ABFW em 20 crianças usuárias de implante coclear por no mínimo três anos. Além disso, foi avaliada a participação familiar no desenvolvimento dessas crianças. Resultados: foi observado que as crianças implantadas apresentam possibilidade de alcançar o desenvolvimento normal de vocabulário, quando comparadas às crianças ouvintes, a depender de diversos fatores. O fator que apresentou influência estatisticamente significante no vocabulário foi a participação familiar, sendo que quanto maior o envolvimento da família no processo terapêutico, melhores os resultados no teste de vocabulário. Conclusão: as crianças implantadas podem apresentar desempenho similar às crianças ouvintes no teste de vocabulário, a depender das variáveis que transcendem a idade à implantação ou mesmo o tempo de uso do implante coclear. A estimulação/ participação familiar no desenvolvimento das crianças se mostrou de extrema importância no desenvolvimento da linguagem oral.

Cochlear Implant: the complexity involved in the decision making process by the family

Objective

to understand the meanings the family attributes to the phases of the decision-making process on a cochlear implant for their child.

Method

qualitative research, using Symbolic Interactionism and Grounded Theory as the theoretical and methodological frameworks, respectively. Data collection instrument: semistructured interview. Nine families participated in the study (32 participants).

Results

knowledge deficit, difficulties to contextualize benefits and risks and fear are some factors that make this process difficult. Experiences deriving from interactions with health professionals, other cochlear implant users and their relatives strengthen decision making in favor of the implant.

Conclusion

deciding on whether or not to have the implant involves a complex process, in which the family needs to weigh gains and losses, experience feelings of accountability and guilt, besides overcoming the risk aversion. Hence, this demands cautious preparation and knowledge from the professionals involved in this intervention.

Assessing the Moderating Effect of the End User in Consumer Behavior: The Acceptance of Technological Implants to Increase Innate Human Capacities

Today, technological implants are being developed to increase innate human capacities, such as memory or calculation speed, and to endow us with new ones, such as the remote control of machines. This study's aim was two-fold: first, to introduce a Cognitive-Affective-Normative (CAN) model of technology acceptance to explain the intention to use this technology in the field of consumer behavior; and second, to analyze the differences in the intention to use it based on whether the intended implant recipient is oneself or one's child (i.e., the moderating effect of the end user). A multi-group analysis was performed to compare the results between the two groups: implant "for me" (Group 1) and implant "for my child" (Group 2). The model largely explains the intention to use the insideable technology for the specified groups [variance explained (R (2)) of over 0.70 in both cases]. The most important variables were found to be "positive emotions" and (positive) "subjective norm." This underscores the need to broaden the range of factors considered to be decisive in technology acceptance to include variables related to consumers' emotions. Moreover, statistically significant differences were found between the "for me" and "for my child" models for "perceived ease of use (PEU)" and "subjective norm." These findings confirm the moderating effect of the end user on new insideable technology acceptance.

Cochlear implantation for a child with cochlear nerve deficiency: parental perspectives explored through narrative

OBJECTIVE

The objective of this study was to explore, from the parents' perspectives, decision-making regarding a cochlear implant (CI) for their child when a favourable outcome is less likely because of abnormal neurophysiology.

DESIGN

The primary research method of this single case study was qualitative interviewing drawing on a narrative approach to elicit the parents' perspectives about their experiences over time. Each parent was interviewed separately, but thematic analyses were undertaken both within and across interviews in order to identify overlaps and differences.

STUDY SAMPLE

Participants included the parents of a five-year old child with severe-profound hearing loss, cochlear nerve deficiency, and bilateral common cavities who had received a CI at the age of 18 months.

RESULTS

Four themes were identified across the four narrative stages that emerged from the parents' accounts of their experiences regarding their daughter's CI. Themes included hope and despair, questioning professionals' motivations, does deafness need a cure, and bringing the child into the family. Although these themes emerged from both parents' accounts, each parent expressed different perspectives and insights within them.

CONCLUSIONS

Findings highlight the central place of parental needs and perspectives in decision-making regarding a CI, particularly in the context of uncertain outcomes.

Parents of deaf children with cochlear implants: a study of technology and community

The cochlear implant (CI) is increasingly used to treat deafness, despite arguments from the deaf community. Deaf children born to hearing parents are the fastest growing group of CI recipients, making parents the primary consumers. Instead of focusing on the controversy over implants, this article examines the clinical structures shaping parental decision-making and how parents integrate clinical practices into family and community. Observations and in-depth interviews were conducted in a CI clinic and at various community sites. The data reveal strong inter-institutional co-operations between the clinic, the state and local school districts. Working together, these institutions anticipate parental needs, foster a CI community and thus increase compliance. I conclude that implantation is an ongoing practice enculturating parents into a new community characterised by the adoption of long-term rehabilitative duties. However, the long-term nature of rehabilitation creates disparities in outcomes, which would be better understood through further research on the social relations in families and across parent networks in the CI community.

Prognosis Tool Based on a Modified Children's Implant Profile for Use in Pediatric Cochlear Implant Candidacy Evaluation

Objectives:

We developed a prediction tool to assist in evaluation of pediatric candidates for cochlear implantation (CI) and to help plan for preoperative and postoperative support.

Methods:

Between 1995 and 2005, 277 patients underwent CI at Children's Hospital Boston. Of these 277 patients, 250 had at least 2 years of post-CI follow-up and adequate pre-CI information for rating by our prediction tool. Of the 250, 106 were randomly selected for inclusion. The patients were divided into group A (auditory/oral communicator); group B (auditory/oral communicator with visual assistance), group C (visual/manual communicator with auditory/oral skills assistance), and group D (will not derive communicative benefit from implant). Predictions were performed with clinical assessment and two statistical techniques: Regression modeling and classification and regression tree (CART) analysis.

Results:

Among patients who became auditory/oral communicators (group A), clinical assessment predicted that outcome accurately 65% of the time, CART analysis had intermediate sensitivity (79%), and regression modeling was the most sensitive (95%). Groups B through D were predicted 45% of the time by regression modeling, 90% of the time by clinical assessment, and 100% of the time by CART analysis.

Conclusions:

A combination of speech-language, medical, and educational constructs can provide a reliable prediction of the communication outcome. Our goal for the prognosis tool is to make it part of the overall candidacy process in supporting decision-making about CI and planning for post-CI therapy.

'Doing the "right" thing': how parents experience and manage decision-making for children's 'normalising' surgeries

Using cleft lip and palate as an exemplar, this article examines parents' decision-making for children in the context of elective treatments which aim to 'normalise' a child's function, appearance, communication or identity. Using purposive and theoretical sampling, 35 parents with children from infancy to young adulthood were recruited through a specialist cleft centre in England. Parents were interviewed in-depth between 2006 and 2008 about their beliefs and motivations in relation to treatment decision-making in this context. A grounded theory approach was used to analyse the data. Findings revealed a core category, 'doing the "right" thing', that encapsulated parents' main concern in relation to their children's treatment and highlighted several emotional, social and cultural considerations underpinning their decision-making stance. Parents fulfilled a perceived 'moral' obligation to be 'good' parents by pursuing the 'normalising' treatments, particularly surgeries, made available to their children. Such treatments were viewed as a way of facilitating their child's social inclusion and helping them reach their full potential. In order to enable their continued pursuit of treatments over the long-term, parents also constructed specialist practitioners as highly competent and particularly trustworthy. This article captures the complexities involved in parents' decision-making for children's elective 'normalising' treatments, where both functional and appearance-related concerns are involved. It suggests that social norms about parenting, physical appearance and healthcare practitioner power may significantly shape decision-making in this context, so that such choices may be viewed primarily as 'moral' rather than social. Services could support parents with such challenges, by gauging their needs for information about surgery and its likely outcomes and providing emotional/decisional support to consider all available options.

Parents' narratives on cochlear implantation: reconstructing the experience of having a child with cochlear implant

This paper discusses parents' narratives on cochlear implantation in Bogotá, Colombia using a qualitative approach. The main research objective was to identify how parents perceived the processes of diagnosis of their child's hearing loss, making the decision for cochlear implantation and the post-surgery period. All participants were hearing couples (n = 13) with similar socio-cultural backgrounds whose children had undergone cochlear implant surgery. Results show why cochlear implants are a very highly valued technological device with great symbolic power for parents. The study also deals with how perceptions about oral/sign language and disability, as well as social expectations for their children's lifetime opportunities, determine how the parents themselves have experienced their journey through the process of their children's cochlear implantation.

What is known about parents' treatment decisions? A narrative review of pediatric decision making

BACKGROUND

With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process.

OBJECTIVE

To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation.

METHODS

Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions.

RESULTS

We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making.

CONCLUSIONS

Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

Communication, psychosocial, and educational outcomes of children with cochlear implants and challenges remaining for professionals and parents

This paper provides an overview and a synthesis of the findings of a large, multifaceted study investigating outcomes from paediatric cochlear implantation. The study included children implanted at several Australian implant clinics and attending a variety of early intervention and educational settings across a range of locations in eastern Australia. It investigated three major aspects of childhood cochlear implantation: (1) parental expectations of their children's implantation, (2) families' decision-making processes, and (3) the communication, social, and educational outcomes of cochlear implantation for deaf children. It employed a mixed-methods approach in which quantitative survey data were gathered from 247 parents and 151 teachers, and qualitative data from semistructured interviews with 27 parents, 15 teachers, and 11 children and adolescents with cochlear implants. The summarised findings highlight several areas where challenges remain for implant clinics, parents, and educators if children with cochlear implants are to reach their full potential personally, educationally, and socially.

Not a "sound" decision: is cochlear implantation always the best choice?

OBJECTIVE

To review the candidacy criteria used to counsel parents of profoundly deaf children, to determine if these criteria have changed over time, and to evaluate eventual communication outcomes for these patients.

DESIGN

Retrospective review of 483 pediatric cochlear implant candidates from September 1995 to December 2006 seen at a tertiary care pediatric hospital.

RESULTS

Out of 483 implant candidates, 191 patients were initially felt not to be favorable candidates based on CI team evaluation. Of this group, 3 had insufficient records to review and were excluded. The remaining 188 patients underwent a detailed analysis of specific possible contraindications to implantation. This included audiologic, medical and psychosocial parameters. The data was divided into two time periods: Group 1 included 44 patients from 1995 to 2000, and Group 2 included 144 patients from 2001 to 2006. In Group 1, there was a higher percentage of children with language deprivation and developmental concerns and patients not ready, compared to Group 2 which had a higher percentage of families not ready and inadequate support systems. Group 1 had a higher percentage of patients who ultimately underwent cochlear implant, but otherwise the two groups were largely similar.

CONCLUSION

Analysis of our data showed that the degree of concern that the cochlear implant team has in relationship to specific candidacy criteria has changed over time. Recommendations against a cochlear implant were often revisited after initial concerns were addressed. The use of a team approach, in conjunction with a validation tool, is important for establishing criteria for successful cochlear implantation in children to support appropriate counseling of patients and families and to plan post-implant management.

Coming to a decision about cochlear implantation: parents making choices for their deaf children

This study combined quantitative and qualitative methods in a sequential approach to investigate the experiences of parents making decisions about cochlear implants for their deaf children. Quantitative findings from a survey instrument completed by 247 parents were extended and elaborated by qualitative findings from in-depth interviews with 27 of the survey respondents. Although parents used a variety of information sources when considering an implant, cochlear implant centers and doctors comprised their major source of information. Most parents found the decision-making process difficult and stressful, but a proportion reported finding the decision easy, believing that there was no other option for their child, and were keen for implantation to proceed as soon as possible. Implications for professionals working with families are discussed.

Parents' views on the quality of life of their children 2-3 years after cochlear implantation

OBJECTIVE

Cochlear implants for children are known to have impact on the lives of recipients and their families in a variety of ways. To obtain a clearer picture of these benefits, we explored the quality of life of 36 Finnish children and their families 2-3 years after unilateral cochlear implantation.

METHODS

The studied children were, on average 5 years old, and had received their implant at the median age of 2 years:5 months (range 1:6 to 12:3). Most (67%) of the children used speech, eight (22%) used speech and signs, and four (11%) used sign language as their main communication mode. A third of the children had concomitant problems in addition to their profound hearing impairment. A validated closed-set questionnaire "Children with cochlear implants: parental perspectives" (available, e.g., at http://www.earfoundation.org.uk/research/questionnaires.html) was used to find out parents' views and experiences on implantation and explore life after it.

RESULTS

Parents were most satisfied with improved/expanded social relations, improved communication (the development of spoken language), general functioning with the help of hearing and improved self-reliance of the child. Benefit of cochlear implantation was also detected with the Categories of Auditory Performance (CAP), which was concordant with views of the parents on the progress of their child in the areas of communication and education. When deciding on implantation, the parents particularly expected auditory information to enhance their child's safety in traffic, joining socially the hearing world, and better employment prospects as adults. Concerning the process of implantation, parents especially valued the know-how and fluent services of the implant centre, positive attitude within the family and information received from other families during the time they were considering the implant decision. Parents also found it important that they have the possibility to influence the communication mode that is used in their child's educational setting.

CONCLUSIONS

Parents report that cochlear implants affect their children in a wide variety of ways that cannot be summarized by a single scale. A broader descriptive framework is required to capture their experiences adequately.

Paediatric cochlear implantation: the views of parents

The purpose of this study was to understand the parental perspective on paediatric cochlear implantation over time. Face-to-face semi-structured interviews were conducted with 216 families of children who were implanted at the Nottingham Paediatric Cochlear Implant Programme between 1989 and 2002, and who were attending an appointment during the study period (July 2001 August 2002). The qualitative data revealed that time played an important role in family experiences of paediatric cochlear implantation. Expectations were continually revised throughout the process, as a result of new knowledge and new technological developments. The results show that outcomes are highly individualistic although parents had a shared hope of the implant enabling the child to function in a "hearing world"; that the biggest area of contention is in respect of their child's education; and that parents talked openly about constraints imposed on them by implantation. The vast majority of parents did not regret their decision to proceed with implantation.

Parental readiness for cochlear implant decision-making

This paper reviews the sparse literature on parental readiness for cochlear implant decision-making. It urges professionals to be cautious when engaging parents in the process and emphasizes the need for professionals to have appropriate training in counselling and parent education. It highlights a range of beliefs and feelings that parents may experience when faced with decision-making; draws attention to possible parent, professional and agency discrepancies in beliefs; and brings to light two common decision-making processes used by families of children with a disability. It concludes with recommendations for improving practice and a call for action.

Phonological patterns in the conversational speech of children with cochlear implants

In this descriptive, longitudinal study, phonological patterns (i.e., natural phonological processes) were examined in a set of conversational speech samples obtained from six young children fitted with cochlear implants. Both developmental and non-developmental patterns were observed. This is consistent with findings from previous studies of the speech of children with hearing loss who wear hearing aids. Several of the patterns found were also the same as those reported in previous studies of children with cochlear implants. One developmental pattern and two non-developmental patterns were significantly correlated with age demonstrating a decrease over time. Trends were evident in several other patterns suggesting possible directions for future investigations.

LEARNING OUTCOMES

The reader will be able to (1) differentiate developmental from non-developmental phonological patterns, (2) identify the patterns that can be seen in the speech of children fitted with cochlear implants, and (3) understand the direction of pattern occurrence over time in this population.

[Cochlear implant: hearing and language in pre-lingual deaf children]

BACKGROUND

Cochlear implant in children, speech perception and oral language, hearing and oral language performance in children with pre-lingual profound sensory-neural hearing impairment, users of cochlear implant.

AIM

To study the hearing and oral language performance of children with pre-lingual bilateral profound sensory neural hearing impairment, users of multi-channel cochlear implant considering the following aspects: age of the child when the research was carried out, time of hearing sensorial privation, time of cochlear implant use, type of cochlear implant, type of speech coding strategy used, familial permeability level in relation to the therapeutic process and cognitive style of the child.

METHOD

Participants of this study were 60 children who were assessed according to hearing and language categories. All of the variables were statistically analyzed. Psycho-social aspects, considering the child's cognitive style and the family's permeability level were also assessed.

RESULTS

Regarding the hearing and language performance with the use of cochlear implant, the intermediate and advanced hearing categories were accomplished by more than half of the children. The statistically significant aspects in the performance of hearing and oral language were: the age of the child upon evaluation, time of hearing sensorial privation, time of cochlear implant use, type of implant, speech sounds coding strategy and familial permeability.

CONCLUSION

The cochlear implant as a treatment for children with pre-lingual sensory-neural hearing impairment is highly effective, although complex, owing to the interaction of variables which interfere in the implanted child's performance. Further studies are needed for the understanding of the implantation complexity in young children.

A preliminary study looking at parental emotions following cochlear implantation

This preliminary research investigated the emotions of parents with cochlear implanted children. The object for the research was first to compare four emotions engendered in parents of deaf children before and after cochlear implantation. Second, to monitor changes in these emotions during a period of up to four years after implantation. Third, to see whether any of the emotions studied was significantly more prominent than the others, and fifth to identify any differences in emotions that were related to the gender of parents. A self-report questionnaire was given to 112 participants of whom 53 replied. There were equal groups of parents in two categories, those with children up to two years after implantation, and those two to four years after implantation. The responses were interpreted using parametric statistics. The results highlight that grief is the strongest emotional condition that parents experience before and up to two years after implantation, alongside family adjustments. Parents of the up to two years after implantation group generally have stronger feelings and are less satisfied than parents in the over two years implanted group. Finally, fathers use denial more than mothers. Considerations for future research and implications for paediatric cochlear implant teams will be discussed.