Ototoxicity management: An investigation into doctors’ knowledge and practices, and the roles of audiologists in a tertiary hospital

Abstract

BackgroundA significant number of medications that are prescribed by doctors to treat cancers, tuberculosis and infections are ototoxic. Disclosure of ototoxic risks is ethical practice as patients have the right to be properly informed about and involved in decisions about their health care. Often, doctors fail to disclose such information.AimThis research investigated whether a group of doctors working in a South African academic hospital inform their patients about the ototoxic risks associated with specific medications, and if not, explore the reasons for it. It was determined what the participants’ knowledge levels of ototoxicity were as knowledge is seen as a precursor to disclosing information to their patients. A further aim of the research was to determine whether audiologists should expand their role by sharing information with patients and other professionals in the management of ototoxicity and in the hospital.MethodThere were 90 participants included in the study through convenience sampling, which represented interns, medical officers, registrars and consultants in the neonatal intensive care unit, intensive care unit, ear–nose–throat, and internal and family medicine departments. The research made use of a descriptive survey design that collected mainly quantitative data and a limited amount of qualitative data through questionnaires. The data were descriptively analysed, and the qualitative data were listed and quantified.ResultsThe research firstly determined the participants’ knowledge and understanding of ototoxicity, and it was found that there was room for improvement. With reference to the current practices of doctors in the prescription of ototoxic medicines, it was found that disclosure of ototoxic risks was limited, mostly because of a lack of time and insufficient knowledge. In comparing knowledge and practices between levels of employment, it was found that particular post levels performed better than others. The participants regarded the role of the audiologist as team member important, although very few referred their patients for audiological monitoring when they prescribe ototoxic medication.ConclusionA need for additional support to doctors was identified, which indicates that audiologists should expand their role to include the provision of continued professional development activities and to renew their efforts to advocate their role in the hospital so that doctors are made aware of the importance to refer their patients for ototoxic screening and monitoring.

What Are the Current Audiological Practices for Ototoxicity Assessment and Management in the South African Healthcare Context?

“…Of the participants that reported making referrals for attending physicians/practitioners, almost all reported not receiving any positive collaboration from the practitioners concerned. This is consistent with Wium and Gerber [21], who found that other health practitioners (i.e., doctors, nurses, pharmacists) are unaware of ototoxicity and the effects thereof, and this explains their reluctance to collaborate with audiologists. This raises implications for audiologists, who should increase awareness about ototoxicity amongst these professionals, and should strengthen their patients' advocacy role for collaborative and efficacious management of patients on ototoxic medications.…”

“…These findings are novel for the South African context as far as implementation of ototoxicity monitoring and management guidelines, on the heels of the 2018 release of the HPCSA guidelines [4]. Furthermore, previous studies have had physicians as participants, have looked at practice in specific conditions such as cancer or TB, while this study focused on audiologists with general ototoxicity assessment and management perspective [21][22][23][24]. Nonetheless, these findings should take cognizance of the identified methodological weaknesses of the study.…”

“…In that study, it was concluded that general practitioners focus and place high priority on the patient's diagnosis over an invisible side effect such as ototoxicity [22]. In another study, Wium and Gerber [21] found that practitioners do not make the referrals to audiologists due to time constraints, as well as due to insufficient knowledge from the practitioner and the patient about ototoxicity signs and symptoms. Internationally, current findings echo those from New Zealand where there is no nationally accepted ototoxicity monitoring programme practice pattern such that the state of monitoring is reported to be "poorly understood" [23].…”

Mixed-methods research: A tutorial for speech-language therapists and audiologists in South Africa

“…Lundie, Erasmus, Zsilavecz and Van der Linde ( 2014 ) experienced a limitation in the sample size of their study that developed a checklist of differential diagnosis of neurogenic stuttering. The use of non-random samples limits generalisation to other populations, as was noted in the study by Wium and Gerber ( 2016 ) that explored doctors’ knowledge of ototoxicity. The problem with adequacy should be countered by calculating the sample statistically.…”

Ototoxicity: Visualized in Concept Maps

“…39 Unfortunately, there may be socioeconomic, psychosocial, and knowledgebased barriers to implementation. 37,[40][41][42] Most OMPs focus on cochleotoxicity. A variety of protocols have been developed for this purpose 43 ; however, their implementation varies.…”