Early Career Research Award PresentationPersonalized Evidence-Based Adult Cochlear Implant Care Using the CIQOL Instruments Since initial FDA approval, cochlear implant (CI) outcomes have been assessed primarily using measures of speech recognition, which persists despite years of research demonstrating poor associations with patients’ self-reported benefits. The Cochlear Implant Quality of Life (CIQOL) instrument suite (including the CIQOL-35 Profile and CIQOL-Expectations with associated CIQOL Functional Staging System) was developed and validated to address this limitation in CI care and enhance the understanding of the real-world functional benefits from cochlear implantation, to advance pre-CI counseling, and to improve how patients are monitored after implantation. This presentation will first describe the development of the CIQOL instruments and then demonstrate through the following two studies their application to provide personalized adult CI care. In study 1 we sought to determine the degree to which CI users’ pre-CI expectations were or were not met after implantation. To accomplish this, we compared CI users’ pre-CI CIQOL-Expectation domain scores (patients’ expected outcomes) to their 12-month post-CI CIQOL-35 Profile domain scores (actual outcomes). Overall, patients’ pre-CI expectations exceeded their 12-month post-CI CIQOL outcomes. Moreover, larger differences between pre-CI expectations and post-CI CIQOL outcomes were associated with higher rates of CI-related decisional regret, but no associations with post-CI speech recognition outcomes were observed. For study 2 we sought to determine the association of pre-CI CIQOL Functional Stage (with a higher stage meaning better pre-CI abilites) on the degree of improvement at 12-months post-CI. We enrolled a prospective cohort of adult CI users who were grouped based on their pre-CI functional stage for each CIQOL domain. These and other outcomes were monitored at 3/6/12 months post-CI. The degree of improvement after cochlear implantation varied based on CI users’ pre-CI functional stage. Specifically for the communication domain, CI users with pre-CI stage 3 communication abilities were over two times less likely to demonstrate improvement after implantation compared to patients in pre-CI stage 1 and 2. Application of the CIQOL instrument suite in these two studies demonstrates that (1) post-CI functional abilities as assessed by the CIQOL-35 Profile fall short of pre-CI expectations for a substantial percentage of adult CI users, and this mismatch appears to be associated with increased CI-related decisional regret and (2) patients at higher pre-CI CIQOL functional stages may be at increased risk of not obtaining improved functional benefit after cochlear implantation compared to their baseline abilities. Results of these two representative studies provide examples of how the CIQOL instruments can be used to enhance CI counseling by applying patient-specific data using an evidence-based, patient-centered approach.
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