Stephanie Peltzer, Medical Tribune News Service
When it comes to making medical decisions about hormone
replacement therapy, doctors may not be meeting the counseling
needs of their patients.
Information offered by the media and friends are more likely to
be considered factors than the medical benefits derived from the
therapy, according to a study in Tuesday's issue of the Annals of
Internal Medicine.
But while most guidelines recommend that physicians explain the
possible medical benefits and drawbacks of postmenopausal hormone
replacement therapy (HRT), they do not address the significance a
woman's personal experiences can have on the decision to undergo
treatment.
``We know that patients in droves are going to complementary
medicine, which says to me that women are finding other ways to
help themselves. That suggests we're missing something in the
doctor's office and that we need to be more attuned to what women
are basing their decisions on,'' said lead researcher Dr. Maureen
T. Connelly of the department of ambulatory care and prevention at
Harvard Medical School in Boston.
Researchers led by Connelly surveyed 26 postmenopausal women
between the ages of 42 and 70 in the Boston area who had received
prescriptions for HRT. Five months after receiving prescriptions
for the therapy, the women were interviewed and asked to describe
their decision-making process and to identify the key factors in
their consideration of whether to undergo the daily pill treatment.
Women identified the factors that influenced their
decision-making as follows: 96 percent cited the opinion of their
medical provider; 81 percent identified media reports as a factor
that influenced them; and 77 percent named the experiences and
opinions of friends. These top three factors were more frequently
mentioned considerations than the reported health benefits of HRT
in preventing breast cancer or osteoporosis, mentioned by 77
percent and 69 percent, respectively.
The guidelines issued by the U.S. Preventive Services Task Force
recommend that physicians consider the impact their opinion may
have on their patient's decision, but they did not include
recommendations to discuss the experiences a patient's friends or
family may have had that would influence the patients' decision.
Guidelines by the American College of Physicians and the American
College of Obstetricians and Gynecologists do not address
discussing the provider's opinion or information a patient may have
received from the media or non-clinical sources.
Connelly called for future guidelines to incorporate patient
concerns and preferences to help doctors understand what patients
are thinking about when they are making decision that affect their
health.
In the meantime, she stresses that people making decisions about
their medical care need be open about their attitudes and
experiences so that physicians may explain or correct any
preconceptions they have about treatments. ``Patients and their
healthcare providers don't realize how important a patient's
personal experiences have been, and they should bring those issues
into the discussion,'' said Connelly.
