The development and clinical use of the Guy's and St Thomas' quality of life questionnaire (GAST) for adult cochlear implant patients.

OBJECTIVES: To Review the benefit of the GAST questionnaire (Tilston, S. 2003. Assessing the quality of life in adult cochlear implant users. MSc dissertation. London: City University.) to measure hearing related quality of life for adults pre and post-cochlear implantation. To develop a scoring methodology as to what score constitutes a significantly 'good' or 'poor' change to better target rehabilitation to those most in need. DESIGN: The GAST Questionnaire was developed using a robust cycle of validation and reliability analyses using the Statistical Package for the Social Sciences (Norusis, M. 1993. SPSS for windows: professional statistics. release 6.0. Chicago: SPSS Inc.). The scoring methodology was developed by dividing 83 patient full data sets into quintiles for the delta of quality of life improvement and the 9-12 month post-implantation GAST score. RESULTS: The GAST questionnaire design was deemed robust. The scoring methodology used led to the 20th percentile score highlighting individuals requiring further support and the 80th percentiles for those suitable for partial booking. CONCLUSION: The GAST questionnaire is a useful way of identifying the patients in need of support as well as to measure patient reported quality of life improvements following cochlear implantation.

Involving young people in decision making about sequential cochlear implantation.

BACKGROUND: The National Institute for Health and Clinical Excellence guidelines recommended young people who currently have one cochlear implant be offered assessment for a second, sequential implant, due to the reported improvements in sound localization and speech perception in noise. The possibility and benefits of group information and counselling assessments were considered. Previous research has shown advantages of group sessions involving young people and their families and such groups which also allow young people opportunity to discuss their concerns separately to their parents/guardians are found to be 'hugely important'. Such research highlights the importance of involving children in decision-making processes. METHODS: Families considering a sequential cochlear implant were invited to a group information/counselling session, which included time for parents and children to meet separately. Fourteen groups were held with approximately four to five families in each session, totalling 62 patients. The sessions were facilitated by the multi-disciplinary team, with a particular psychological focus in the young people's session. RESULTS: Feedback from families has demonstrated positive support for this format. Questionnaire feedback, to which nine families responded, indicated that seven preferred the group session to an individual session and all approved of separate groups for the child and parents/guardians. CONCLUSION/DISCUSSION: Overall the group format and psychological focus were well received in this typically surgical setting and emphasized the importance of involving the young person in the decision-making process. This positive feedback also opens up the opportunity to use a group format in other assessment processes.