Patient-Identified Needs for Hormone Replacement Therapy Counseling: A Qualitative Study

Connelly, Maureen T.; Ferrari, N.; Hagen, Nicole; Inui, Thomas S.

doi:10.7326/0003-4819-131-4-199908170-00005

Cited by 38 publications

(19 citation statements)

References 14 publications

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“…Some interviewees felt the WHI empowered them, whereas others felt they lacked the tools to assist their patients. These findings are consistent with prior studies that found that women 25 and physicians 26,27 were dissatisfied with shared decision making and had counseling needs that published guidelines did not address. In either case, in the face of uncertainty and inadequate information, interviewees felt the final choice regarding HT use comes down to a woman's preference.…”

Section: Discussionsupporting

confidence: 90%

How the Women’s Health Initiative (WHI) Influenced Physicians’ Practice and Attitudes

et al. 2007

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BACKGROUND:The landmark Women's Health Initiative (WHI) Postmenopausal Hormone Therapy Trial published in 2002 showed that the health risks of combination hormone therapy (HT) with estrogen and progestin outweighed the benefits in healthy postmenopausal women. Dissemination of results had a major impact on prescriptions for, and physician beliefs about HT. No study has fully examined the influence of the widely publicized WHI on physicians' practice and attitudes or their opinions of the scientific evidence regarding HT; in addition, little is known about how physicians assist women in their decisions regarding HT. DESIGN AND PARTICIPANTS:We conducted in-depth telephone interviews with family practitioners, internists, and gynecologists from integrated health care delivery systems in Washington State (n=10 physicians) and Massachusetts (n=12 physicians). Our objectives were to obtain qualitative information from these physicians to understand their perspectives on use of HT, the scientific evidence regarding its risks and benefits, and counseling strategies around HT use and discontinuation.APPROACH: We used Template Analysis to code transcribed telephone interviews and identify themes. RESULTS:Physicians were conflicted about the WHI results and its implications. Seven themes identified from in-depth interviews suggested that the WHI (1) was a ground-breaking study that changed clinical practice, including counseling; (2) was not applicable to the full range of patients seen in clinical practice; (3) raised concerns over the impact of publicized health information on women; (4) created uncertainty about the risks and benefits of HT; (5) called for the use of decision aids; (6) influenced discontinuation strategies; and (7) provided an opportunity to discuss healthy lifestyle options with patients. As a result of the WHI, physicians reported they no longer prescribe HT for prevention and were more likely to suggest discontinuation, although many felt women should be in charge of the HT decision.CONCLUSIONS: Physicians varied in their opinions of HT and the scientific evidence (positive and negative). Whereas the WHI delineated the risks and benefits of HT, physicians reported that decision aids are needed to guide discussions with women about menopause and HT. Better guidance at the time of WHI study publication might have been valuable to ensure best practices.

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Section: Discussionsupporting

confidence: 90%

How the Women’s Health Initiative (WHI) Influenced Physicians’ Practice and Attitudes

et al. 2007

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“…1,2 Long-term continuation is especially important for preventing the loss of bone mineral density (BMD), 1 a factor cited by a large percentage of patients as influencing their decision making regarding HRT. 3 A small number of low-dose estrogen formulations have been approved in the United States for preventing menopausal symptoms or osteoporosis: oral conjugated equine estrogens (CEEs) or esterified estrogens at 0.3 mg/d; oral micronized estradiol at 0.5 mg/d; and transdermal 17␤-estradiol at 0.025 mg/d. Genant et al 4 demonstrated that esterified estrogens at 0.3 mg/d for 24 months, combined with a calcium supplement, increased BMD compared with baseline and placebo.…”

Section: T He Use Of Lower Doses Of Es-mentioning

confidence: 99%

Effect of Lower Doses of Conjugated Equine Estrogens With and Without Medroxyprogesterone Acetate on Bone in Early Postmenopausal Women

Lindsay¹

2002

JAMA

322

128

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“…The need for personal consultation has been documented in previous studies 27,33 and may be a reflection of the frustrations women experienced with information searches and the decision-making process. Rather than wading through a vast amount of information sources with questionable reliability, they prefer expert advice with an opportunity to ask questions.…”

Section: Discussionmentioning

confidence: 92%

Women's needs for CAM information to manage menopausal symptoms

et al. 2007

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Women feel they are not sufficiently informed to make safe decisions regarding CAM treatment options to alleviate menopausal symptoms. Family physicians are a trusted information source and have an important role in providing women with that information. Brochures containing evidence-based information and a list of newsletters or books that include personal accounts, available in physician's offices and during personal consultations at women's health centers, are offered as a possible solution. A website is another possibility for distributing this information.

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Patient-Identified Needs for Hormone Replacement Therapy Counseling: A Qualitative Study

Abstract: Many women in a managed care organization who accepted a prescription for HRT identified counseling needs that are not included in widely used HRT guidelines.

Cited by 38 publications

References 14 publications

How the Women’s Health Initiative (WHI) Influenced Physicians’ Practice and Attitudes

How the Women’s Health Initiative (WHI) Influenced Physicians’ Practice and Attitudes

Effect of Lower Doses of Conjugated Equine Estrogens With and Without Medroxyprogesterone Acetate on Bone in Early Postmenopausal Women

Women's needs for CAM information to manage menopausal symptoms

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