Exploring the recruitment, ethical considerations, conduct and information dissemination of an audiology trial: a pretrial qualitative study (q-COACH).

INTRODUCTION: Randomised controlled trials (RCTs), while still considered the gold standard approach in medical research, can encounter impediments to their successful conduct and the dissemination of results. Pretrial qualitative research can usefully address some of these impediments, including recruitment and retention, ethical conduct, and preferred methods of dissemination. However, pretrial qualitative work is rarely undertaken in audiology. The Comparison of outcomes with hearing aids and cochlear implants in adults with moderately severe-to-profound bilateral sensorineural hearing loss (COACH) is a proposed RCT aiming to clarify when hearing aids (HAs) or cochlear implants (CIs) are the most suitable for different degrees of hearing loss and for which kinds of patients. q-COACH is a pretrial, qualitative study examining stakeholders' experiences of HAs and CIs, current clinical practices and stakeholders' perspectives of the design, conduct and dissemination plans for the proposed COACH study. METHODS: Twenty-four participants including general practitioners, audiologists, adult HA users, and adult support networks undertook either semi-structured individual or paired interviews and completed demographic questionnaires. Data were analysed thematically. RESULTS: Four key themes arose from this study: 1) rethinking sampling and recruitment strategies, 2) ethical considerations, 3) refining trial conduct, and 4) interconnected, appropriate and accessible methods of results dissemination. CONCLUSIONS: This qualitative investigation identified key considerations for the proposed RCT design, conduct and dissemination to help with successful implementation of COACH, and to indicate a plan of action at all RCT stages that would be acceptable to potential participants. By drawing on the perspectives of multiple key stakeholders and including a more general discussion of their experience and opinions of hearing loss, hearing device use and service availability, the study revealed experiential and ethical paradigms in which stakeholders operate. In so doing, q-COACH has exposed the benefits of preliminary qualitative investigations that enable detailed and rich understandings of the phenomenon at stake, forestalling problems and improving the quality of trial design, conduct and dissemination, while informing future RCT development discussions.

Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education.

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

A systematic review of ethics knowledge in audiology (1980-2010).

PURPOSE: The purpose of this research was to apply multiple perspectives as part of a systematic review to analyze literature regarding ethics in audiology. Audiologists are particularly vulnerable to the changing requirements of the discipline that compel them to straddle both professional obligations and business principles, creating a hybrid professional. METHOD: The authors used a 2-phase mixed-method approach to analyze publications. Publications were sorted into categories, namely, ethics approach, author, decade, role of the audiologist, component of morality, and common themes. The sample consisted of peer-reviewed articles cited in MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide Information, and Academic Search Premier electronic databases and non-peer-reviewed articles in Seminars in Hearing. RESULTS: The publications were predominantly philosophical, focused on the rehabilitative role of the audiologist, and addressed the moral judgment component of moral behavior. CONCLUSIONS: Despite the fact that knowledge of ethics grew between 1980 and 2010, this retrospective analysis identified gaps in current knowledge. Research is needed to address the unique ethical problems commonly encountered in all 8 roles of the audiologist; patient perspectives on ethics; ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in audiology.

Audiology: student perception of preceptor and fellow student ethics.

BACKGROUND: Health care professionals are expected to uphold high ethical standards. Recently, ethical practices in health care have received increased scrutiny and study in an effort to ensure that clinicians meet such high ethical standards in serving their patients and clients. The American Academy of Audiology's Code of Ethics establishes professional standards that allow for the proper discharge of an audiologist's responsibilities while maintaining the integrity of the profession. Under this code, student academy members are included and required to abide by the code, the same as practicing members. The code is composed of a preamble and eight principles. METHOD: The present study provides an overview of students' perceptions across a broad spectrum of ethical topics governing our profession. Specifically, this study examined audiology students' perceptions of preceptor ethics relating to these eight principles using an online survey. RESULTS: Responses were collected from 143 of 600 audiology students contacted and indicated that they believed that their preceptors consistently followed each of the eight principles. Results also indicated that students believe fellow students also behave ethically and that it is the primary responsibility of academic faculty, not preceptors, to teach ethics. CONCLUSION: It can be concluded that preceptors are perceived by their students to be acting with high ethical standards. However, more research and discussion may be needed to determine who should teach these ethics to students.

Procesos silábicos y otros procesos preléxicos / Syllabic and other prelexical processes

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Intervención naturalista / No disponible

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From pillars to posts: some reflections on community service six years on.

Speech-Language Therapy and Audiology graduates have worked in community service for 6 years. An evaluation of the impact of this strategy is now seen as important. In this discussion paper we report on the content and process of feedback sessions with 132 graduates from the University of the Witwatersrand during their community service placements from 2003-2008. Experiences and perceptions of these graduates are discussed in relation to a model as well as in relation to additional research conducted with our profession and other community service professions. Themes discussed include professional and technical issues, systemic and managerial issues, interpersonal issues and ethical issues. Perceptions on the adequacy of training are also described. The overall goals of community service are considered as well as indices for measuring success. Implications are considered for training institutions, for the Department of Health and for the profession.