(814) Barriers To Cochlear Implantation: A Qualitative Analysis

Introduction: Cochlear implantation (CI) remains underutilized despite well-established candidacy criteria. A deeper understanding of patient-centered experiences shaping readiness and decision-making is needed to improve equitable access to CI.

Methods: Semi-structured interviews were conducted with adults (≥18 years) with bilateral moderate-to-profound sensorineural hearing loss (HL) who met established audiometric criteria for CI, underwent CI candidacy counseling, and ultimately elected not to proceed with implantation. Interviews (n=25, 32% coded to consensus) were analyzed using NVivo 15 following standard qualitative methodologies.

Results: Participants described pervasive functional, social, and emotional effects of HL, often managed through compensatory strategies and lifestyle modifications that normalized impairment and delayed interventions. Worsening communication difficulties and loss of independence associated with HL ultimately reached a threshold that motivated many participants to pursue CI candidacy evaluation. Key barriers to CI included fear of the unknown, anticipated lifestyle disruptions, medical comorbidities, financial concerns, and healthcare system distrust. Many participants expressed concern about losing residual hearing and a strong desire to explore alternative or less invasive treatment options before considering implantation. Healthcare system factors, including inconsistent counseling, limited follow-up, and fragmented care, further contributed to decisional uncertainty and erosion of trust.

Conclusions: CI decision-making is a dynamic process shaped by coping strategies and evolving readiness. Fear, residual hearing concerns, system barriers, and inconsistent counseling appear to delay implantation.