Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl The child doesn't hear? On breaking bad news as perceived by parents and audiologists Miriam Geal-Dor a,b,* , Cahtia Adelman a,b a Department of Speech and Hearing, Hadassah Hebrew University Medical Center, Israel b Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel ARTICLE INFO Keywords: Child hearing loss Breaking bad news Questionnaire ABSTRACT Objective: The object of this study was to explore how parents experienced receiving the news of their child's hearing loss, and how audiologists experienced the situation of conveying the diagnosis, in order to examine improvements to the current process. Method: A questionnaire regarding different aspects of breaking the news was developed. 48 Arabic and Hebrew speaking parents of hearing impaired children answered the questionnaire. A similar questionnaire was filled out by 31 audiologists. Results: Findings demonstrate parents' general satisfaction with the manner in which the diagnosis was deliv- ered. According to the parents' reports, receiving the diagnosis evoked negative feelings of fear, depression and difficulty believing the diagnosis. Parents' feelings were influenced by their cultural background, such as their ethnic identity, religious practice and difficulties due to language barriers. The audiologists described concern and anxiety when breaking bad news, but they felt they were able to present the diagnosis. The audiologists felt that they were not trained in this aspect, and the ability was acquired through experience. Both parents and audiologists agreed that the audiologist should be the professional to deliver the diagnosis. All emphasized sensitivity and professionalism as necessary qualities. Whereas audiologists were of the opinion that the most important information to transmit was the type of hearing loss, the parents were most interested in discussing their feelings, the rehabilitation process, and talking to other parents. Conclusions: Overall, results reveal that breaking bad news of a child's hearing loss has been done fairly well. Due to the parents' reports of the need for emotional support, it is suggested that audiologists receive further training and adjust to personal and cultural differences. Recommendations include establishing an appropriate setting and ensuring that an interpreter is available when necessary. Further emotional support may be provided through establishment of a family support network. 1. Introduction Perhaps one of the most challenging aspects of work as an audiol- ogist is informing a family that their child has a hearing loss. Buckman [1] defined bad news as any news that adversely and seriously affects an individual's view of his or her future. More specifically Fitzpatrick et al. [2] state that parents describe the hearing loss as a phenomenon that not only affects the child, but changes the lives of the family and affects decisions such as career, finances, and place of residence. In the past, hearing loss was tested for in the high risk population or when developmental milestones were delayed, or after failure in screening tests in well baby clinics at the age of 7–9 months, and therefore parents were somewhat prepared to receive news of hearing impairment in their child. Nowadays, with the implementation of newborn hearing screening programs, Kurtzer-White & Luterman [3] raised the point that newborn hearing screening promoted early identification and rehabilitation, but may have left parents without enough support in the event of diagnosis of hearing loss. Parents reported emotional reactions of shock and grief upon di- agnosis of hearing loss. The period immediately after detection of hearing loss is perceived by parents as the most stressful. Furthermore, the manner in which the news was conveyed influenced their approach, for the long term, towards the hearing loss, the staff and the https://doi.org/10.1016/j.ijporl.2018.06.044 Received 3 May 2018; Received in revised form 26 June 2018; Accepted 26 June 2018 * Corresponding author. Audiology Department, Hadassah Medical Center, POB 1200, Jerusalem, Israel. E-mail address: gmiriam@hadassah.org.il (M. Geal-Dor). International Journal of Pediatric Otorhinolaryngology 112 (2018) 113–120 Available online 28 June 2018 0165-5876/ © 2018 Elsevier B.V. All rights reserved. T