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

Objective: 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. Data Sources: Embase, Ovid Medline, Scopus, The Cochrane Library, APA PsycINFO, CINAHL Plus, and ClinicalTrials.gov. Methods: 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. Results: 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. Conclusions: 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. Level of Evidence: N/A.