Parental Decision-Making in Management of Childhood Hearing Loss: A Systematic Review.

Abstract

When counseling parents regarding the management of their child's hearing loss (HL), understanding parents' motivations is paramount. Our objective was to synthesize the factors affecting parental decision-making regarding hearing device initiation in the existing literature. Embase, Ovid Medline, Scopus, The Cochrane Library, APA PsycINFO, CINAHL Plus, and ClinicalTrials.gov. A medical librarian conducted a systematic search for publications on parental decision-making in their child's HL management. Two reviewers independently assessed studies and extracted quotes for analysis. From 462 abstracts, 161 were potentially relevant, and 48 studies were included. Of these, 32 (67%) discussed cochlear implants (CIs), 8 (17%) discussed other devices, and 8 (17%) addressed both. Three broad themes emerged: Practical considerations, Value-Based considerations, and Information Gathering. Key sub-themes in CI decision-making were oral communication (27/40), child autonomy (20/40), and ethical/religious (8/40) or Deaf culture (10/40) considerations. For non-CI-deciding parents, concerns about aesthetics (4/16) or bullying (6/16), and understanding of audiologic results (3/16) were important factors not reported by CI-deciding parents. Experiences of other families were more commonly important in CI decision-making (24/40) than for other devices (6/16). Parents perceived medical professionals as biased towards CI (9/40) and felt overtly rushed and pressured. Parents considering other devices reported that information was one-sided (5/16), but did not often feel pressured. Parents considering hearing devices for their children assess Practical considerations, personal values, and varied information sources. Sub-themes within these categories differed by device type. Medical professionals should elicit parental values and offer individualized counseling during conversations about hearing devices. N/A.