父母拒绝儿童人工耳蜗植入的相关因素：一项回顾性队列研究

文献信息

中文摘要

重要性： 了解家庭尽管符合适应证仍拒绝人工耳蜗植入的原因，对于优化咨询和提高听力康复的可及性至关重要。
目的： 识别与符合条件的儿童候选者中父母拒绝人工耳蜗植入相关的临床、人口学和心理社会因素。
设计： 为期9年的回顾性队列研究。
场所： 三级儿科转诊中心。
参与者： 在加拿大不列颠哥伦比亚省因感音神经性听力损失被转诊接受人工耳蜗植入评估的0至18岁儿童。
暴露因素： 2015年4月至2024年5月期间在人工耳蜗植入候选资格评估中记录的临床、人口学和心理社会特征。
主要结局指标： 父母拒绝人工耳蜗植入。
结果： 共纳入343例转诊（50.4%为女性，中位年龄4岁，IQR 9）。其中，最终有205例患者被提供人工耳蜗植入（CI），其中20例拒绝（9.8%）。拒绝的家庭在转诊时年龄显著更高（11岁 vs 2岁，P < .001）、听力损失持续时间更长（5年 vs 1年，P = .01），且家庭支持较少（66.9% vs 25%，P = .015）。明确记录偏好口语交流以及无听力损失家族史与CI拒绝的几率较低相关（分别降低76%和67%）。CI不合格通常源于长期听觉剥夺、助听器获益充分，或耳蜗神经缺失或发育不良。在拒绝植入的家庭中，常提及的原因包括认为助听放大已提供足够听力、对手术风险的担忧，以及对预期功能获益的不确定性。
结论： 年龄较大、听力损失持续时间增加、家庭支持有限以及父母对口语交流的偏好较低，与符合条件的儿童候选者中人工耳蜗植入拒绝可能性增加相关。
相关性： 了解与CI拒绝相关的因素可能有助于临床医生量身定制咨询和以家庭为中心的决策。

英文摘要

IMPORTANCE: Understanding why families decline cochlear implantation despite candidacy is critical for optimizing counseling and improving access to hearing rehabilitation.
OBJECTIVE: To identify clinical, demographic, and psychosocial factors associated with parental refusal of cochlear implantation among eligible pediatric candidates.
DESIGN: 9-year retrospective cohort study.
SETTING: Tertiary care pediatric referral center.
PARTICIPANTS: Children aged 0 to 18 years with sensorineural hearing loss referred for cochlear implant evaluation in British Columbia, Canada.
EXPOSURES: Clinical, demographic, and psychosocial characteristics documented during the cochlear implant candidacy evaluation between April 2015 and May 2024.
MAIN OUTCOME MEASURES: Parental refusal of cochlear implantation.
RESULTS: 343 referrals were included (50.4% female, median age 4 years, IQR 9). Of these, 205 patients were ultimately offered cochlear implantation (CI), 20 of whom declined (9.8%). Families who declined had a significantly higher age at the time of referral (11 years vs 2 years, P < .001), a longer duration of hearing loss (5 years vs 1 year, P = .01), and less family support (66.9% vs 25%, P = .015). A clearly documented preference for spoken communication and absence of family history of hearing loss was associated with lower odds of CI refusal (76% and 67% reduction respectively). CI ineligibility commonly resulted from prolonged auditory deprivation, adequate benefit from hearing aids, or absent or hypoplastic cochlear nerves. Among families declining implantation, commonly cited reasons included perceived adequate hearing with amplification, concerns regarding surgical risks, and uncertainty regarding expected functional benefit.
CONCLUSIONS: Older age, increased duration of hearing loss, limited family support, and lower parental preference for spoken communication were associated with increased likelihood of cochlear implant refusal among eligible pediatric candidates.
RELEVANCE: Understanding factors associated with CI refusal may help clinicians tailor counseling and family-centered decision-making.