Telemedicine for adults with cochlear implants in the UK (CHOICE): protocol for a prospective interventional multi-site study (Preprint)

UNSTRUCTURED Introduction Cochlear implants provide hearing to more than 600,000 people with deafness worldwide; patients require lifelong follow-up. Care for adults with implants in the UK occurs at one of 19 centres, which may be far from the patient’s home. In a previous RCT, we successfully introduced person-centred care. We designed, implemented and evaluated a remote care pathway: a personalised online support tool, home hearing check, self device adjustment, and upgrading of sound processors at home rather than in clinic. The remote care group had a significant increase in empowerment after using the tools; patients and clinicians were keen to continue. We would now like to scale up these improvements as an option to the more than 12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and roll out to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centred and scalable service; more satisfied and engaged patients and clinicians. Methods and analysis This project will scale up and evaluate a person-centred long-term follow-up pathway for adults using cochlear implants using a personalised website including a home hearing check, upload of photos of cochlear implant site, listening in noise and music practice, spares ordering, questionnaires, and other resources. Both quantitative and qualitative analyses will occur. Ethics and dissemination Ethical approval was received in November 2018 from the South Central - Hampshire A Research Ethics Committee (REC reference 18/SC/0658, IRAS project ID 242575) and HRA and Health and Care Research Wales (HCRW). Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports, and social media.

[1]  Jennifer Dixon,et al.  The NHS long term plan , 2019, British Medical Journal.

[2]  M. Weal,et al.  Feasibility of personalised remote long-term follow-up of people with cochlear implants: a randomised controlled trial , 2018, BMJ Open.

[3]  Per Winkel,et al.  When and how should multiple imputation be used for handling missing data in randomised clinical trials – a practical guide with flowcharts , 2017, BMC Medical Research Methodology.

[4]  Trisha Greenhalgh,et al.  Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies , 2017, Journal of medical Internet research.

[5]  S. T. Goverts,et al.  Assessing speech recognition abilities with digits in noise in cochlear implant and hearing aid users , 2015, International journal of audiology.

[6]  J. Festen,et al.  The digits-in-noise test: assessing auditory speech recognition abilities in noise. , 2013, The Journal of the Acoustical Society of America.

[7]  H. Cullington.  What do our service users really want , 2013 .

[8]  Hideo Aizaki,et al.  Basic Functions for Supporting an Implementation of Choice Experiments in R , 2012 .

[9]  R. Thomson,et al.  Shared Decision Making: A Model for Clinical Practice , 2012, Journal of General Internal Medicine.

[10]  G. Bonsel,et al.  Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) , 2011, Quality of Life Research.

[11]  M. Manrique,et al.  Worldwide trends in bilateral cochlear implantation , 2010, The Laryngoscope.

[12]  C. May,et al.  Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory , 2009 .

[13]  Blake S Wilson,et al.  Cochlear implants: current designs and future possibilities. , 2008, Journal of rehabilitation research and development.

[14]  Jim Bellows,et al.  Is Patient Activation Associated With Outcomes of Care for Adults With Chronic Conditions? , 2007, The Journal of ambulatory care management.

[15]  F. Reed Johnson,et al.  Experimental Design For Stated-Choice Studies , 2006 .

[16]  T. Houtgast,et al.  How we do it: The Dutch functional hearing–screening tests by telephone and internet , 2006, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[17]  Judith H Hibbard,et al.  Development and testing of a short form of the patient activation measure. , 2005, Health services research.

[18]  T. Houtgast,et al.  Results From the Dutch Speech-in-Noise Screening Test by Telephone , 2005, Ear and hearing.

[19]  J. Hibbard,et al.  Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. , 2004, Health services research.

[20]  Tammo Houtgast,et al.  Development and validation of an automatic speech-in-noise screening test by telephone , 2004, International journal of audiology.

[21]  George W. Torrance,et al.  Multi-Attribute Health Status Classification Systems , 1995, PharmacoEconomics.

[22]  Elizabeth Murray,et al.  Improving the normalization of complex interventions: part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT) , 2018, BMC Medical Research Methodology.

[23]  Ishan Ann Tsay,et al.  Using a patient-driven software tool for programming multiple cochlear implant patients simultaneously in a telemedicine setting , 2012 .

[24]  B. Kanninen,et al.  Valuing environmental amenities using stated choice studies : a common sense approach to theory and practice , 2010 .

[25]  Tim Benson,et al.  Evaluation of a new short generic measure of health status: howRu. , 2010, Informatics in primary care.

[26]  Gary Wills,et al.  Introduction to the Lifeguide: Software Facilitating the Development of Interactive Behaviour Change Internet Interventions , 2022 .