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

IF 1.4 Q2 OTORHINOLARYNGOLOGY
COCHLEAR IMPLANTS INTERNATIONAL Pub Date : 2022-05-01 Epub Date: 2022-02-15 DOI:10.1080/14670100.2022.2035916
Andrew Hall, Fiona McClenaghan, Robert Nash, Azhar Shaida
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引用次数: 1

Abstract

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.

儿童人工耳蜗植入评估后,患者、家长和多学科团队不进行人工耳蜗植入的理由。
目的:评估转介到人工耳蜗小组的儿科患者,尽管接受了评估,但没有接受人工耳蜗植入。找出造成这种情况的根本原因。方法:对2014年6月至2019年6月在伦敦两家独立的儿科人工耳蜗植入教学医院进行的患者进行回顾性病例回顾。结果:在研究期间,两个机构共评估了921名儿科患者。196例(21%)未进行手术。114例(61%)患者决定不进行手术,74例(39%)患者决定不进行人工耳蜗植入。总共有8名(4%)患者在没有记录的情况下退出了该计划。讨论:无数的因素影响着临床医生、患者和家长的决策过程。家长/患者反对植入的最主要原因是希望继续使用现有的通信手段(35%),其次是担心手术风险(15.8%),以及希望允许患者根据未来的技术独立做出未来的决定(6.1%)。人工耳蜗团队指导的决定主要是由于超出了NICE标准27(36.5%)或全身麻醉风险19(25.7%),此外还有沟通问题11(14.9%)。结论:人工耳蜗植入术的决策不可低估。与多学科团队进行广泛的讨论和探索可以帮助决策,但时间尺度和对决策后果的评估不可避免地会带来压力。探索不植入的原因强调了多专业方法管理这些患者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
COCHLEAR IMPLANTS INTERNATIONAL
COCHLEAR IMPLANTS INTERNATIONAL Medicine-Otorhinolaryngology
CiteScore
3.10
自引率
0.00%
发文量
29
期刊介绍: Cochlear Implants International was founded as an interdisciplinary, peer-reviewed journal in response to the growing number of publications in the field of cochlear implants. It was designed to meet a need to include scientific contributions from all the disciplines that are represented in cochlear implant teams: audiology, medicine and surgery, speech therapy and speech pathology, psychology, hearing therapy, radiology, pathology, engineering and acoustics, teaching, and communication. The aim was to found a truly interdisciplinary journal, representing the full breadth of the field of cochlear implantation.
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