Patients' and clinicians' attitudes after the Women's Health Initiative study

Blümel, Juan E.; Castelo-Branco, Camil; Chedraui, Peter; Binfa, Lorena; Dowlani, Bravna; Gómez, M. S.; Sarrá, Salvador

doi:10.1097/01.gme.0000075503.60230.61

Cited by 78 publications

(39 citation statements)

References 15 publications

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“…Similar results have been reported in repeated cross-sectional surveys in Italy (12), Australia (20), and Switzerland (21), and in single cross-sectional surveys in the United States (22,23) [56% of users attempted to stop (10), 63% of users reported discontinuation (24)], Chile (25), and Sweden (11,26). Databases from five US health maintenance organizations show a 46% decline in HT prescription between September 1999 and December 2002 (9), and three other studies in the United States report a fall in prescription patterns (27)(28)(29).…”

Section: Discussionsupporting

confidence: 85%

Discontinuation of hormone therapy in the French GAZEL cohort 1990–2006

Ringa

Fritel

Varnoux

et al. 2010

Fertility and Sterility

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Section: Discussionsupporting

confidence: 85%

Discontinuation of hormone therapy in the French GAZEL cohort 1990–2006

Ringa

Fritel

Varnoux

et al. 2010

Fertility and Sterility

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“…For example, physicians were less favorable toward using HT for prevention 9,10 and gynecologists indicated they would continue to prescribe HT despite the WHI results 11,12 and that they were more likely to hold positive views of HT than were general internists. 10,13,14 Although there are growing data about physician attitudes since the release of the WHI, [9][10][11][13][14][15][16][17][18] these studies provide little insight into physicians' thoughts regarding the scientific evidence about HT-nor the impact of the WHI on day-to-day clinical practice. No studies have collected data on the strategies physicians use when counseling women about the use of HT, especially regarding discontinuation.…”

Section: Resultsmentioning

confidence: 99%

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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“…This decrease also appeared to coincide with changes in women's and doctor's attitudes to HT (24)(25)(26)(27). There are few studies, however, regarding changes in attitudes towards the menopause transition, which might also have been affected by the media reports and should be clarified.…”

Section: Introductionmentioning

confidence: 96%

Attitudes towards the menopause and hormone therapy over the turn of the century

et al. 2007

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Objective: To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT). Material and methods: In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT. Results: Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies. Conclusions: Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women’s attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women’s actual use of HT. Probably women’s and health care provider’s apprehension of the risk-benefit balance of HT use is one such factor.Original publication: Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffmann, Susanne Liffner and Mats Hammar, Attitudes towards the menopause and hormone therapy over the turn of the century, 2007, Maturitas, (56), 1, 12-20. http://dx.doi.org/10.1016/j.maturitas.2006.05.002. Copyright: Elsevier B.V., http://www.elsevier.com

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Patients' and clinicians' attitudes after the Women's Health Initiative study

Abstract: There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.

Cited by 78 publications

References 15 publications

Discontinuation of hormone therapy in the French GAZEL cohort 1990–2006

Discontinuation of hormone therapy in the French GAZEL cohort 1990–2006

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

Attitudes towards the menopause and hormone therapy over the turn of the century

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