Women's use of information regarding hormone replacement therapy

Menopause Research and The Dominance of the Biomedical Model 1984-1994

Popular images and stereotypes of women in the menopausal age range are overwhelmingly negative. Because these stereotypes are likely both to influence and to be influenced by published scholarship, it is particularly important to examine conventional knowledge as it has been represented in science-based journals. In an effort to examine the extent and nature of the accepted knowledge base regarding menopause, a survey of both medical and psychological journal articles was conducted for the years 1984-1994. Publication trends revealed a predominance of articles based on a biomedical paradigm and the virtual absence of articles presenting alternative perspectives on midlife. Ten serious methodological problems common to this literature are delineated, including such fundamental errors as failure to acquire baseline data, lack of control groups, vague operational definitions, and blatantly pejorative language. We also discuss conceptual flaws implicit in the predominant paradigm, including the messages that women are different, sicker, and weaker than a normal, male, ideal. Finally, we consider the implications of these social constructions for the political, social, and psychological status of women.

Women's perceptions of hormone replacement therapy: risks and benefits (1980–2002). A literature review

OBJECTIVES

Many postmenopausal women are reluctant to take hormone replacement therapy (HRT) and those who do are likely to discontinue within 1 year. Setting aside the beliefs and prejudices of the prescriber, women's own perceptions of risks and benefits may influence their willingness to accept and then persevere with HRT. We conducted a systematic literature review relating women's beliefs about HRT to acceptance and adherence.

METHODS

Using standard guidelines for systematic search procedures, we identified 112 papers (published during 1980-2002) from databases such as Medline, PsycINFO and the NHS and Cochrane libraries.

RESULTS

Women hold both positive and negative beliefs about HRT. Their perceptions of benefits are often countered by concerns over potential adverse effects, beliefs that are sometimes at odds with the clinical evidence. The use and discontinuation of HRT are influenced more by short-term symptom relief than by considerations of long-term benefits. Many women who refuse HRT believe that the menopause is a natural event that does not warrant 'chemical' intervention. Doctors and nurses are not used to their full capacity as an education and information resource to counter the possibility of unbalanced stories in the media.

CONCLUSIONS

Addressing women's preconceptions about HRT should be an important part of the process of prescribing and review. Such an approach will help ensure that a woman's decision to start or continue HRT is informed by an understanding of the known risks and benefits, rather than by myths or mistaken beliefs about the menopause or HRT.

Hormone therapy, dilemmas, medical decisions

The decision for women to go on hormone therapy (HT) remains controversial. An historical oscillation of beliefs exists related in part to expectations of the medicinal value of HT over longer-term use beyond the initial peri-menonpausal period. Studies thought to resolve issues surrounding the efficacy of HT were perhaps overstated as confusion still permeates the decision making with regard to HT. Overzealous advertising and exaggerated understanding of the results (negative or positive) undermine patient and physician decision making. There remains no magic bullet with regard to HT. What remains is still the possibility of HT longer-term efficacy on diverse end organ systems with pockets of clinical and scientific ambiguity while working to engender reasonable expectations.

Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium

This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against.

A systematic review of information in decision aids

OBJECTIVE

We completed a systematic review of information reported as included in decision aids (DAs) for adult patients, to determine if it is complete, balanced and accurate.

SEARCH STRATEGY

DAs were identified using the Cochrane Database of DAs and searches of four electronic databases using the terms: 'decision aid'; shared decision making' and 'patients'; 'multimedia or leaflets or pamphlets or videos and patients and decision making'. Additionally, publications reporting DA development and actual DAs that were reported as publicly available on the Internet were consulted. Publications were included up to May 2006.

DATA EXTRACTION

Data were extracted on the following variables: external groups consulted in development of the DA, type of study used, categories of information, inclusion of probabilities, use of citation lists and inclusion of patient experiences.

MAIN RESULTS

68 treatment DAs and 30 screening DAs were identified. 17% of treatment DAs and 47% of screening DAs did not report any external consultation and, of those that did, DA producers tended to rely more heavily on medical experts than on patients' guidance. Content evaluations showed that (i) treatment DAs frequently omit describing the procedure(s) involved in treatment options and (ii) screening DAs frequently focus on false positives but not false negatives. About 1/2 treatment DAs reported probabilities with a greater emphasis on potential benefits than harms. Similarly, screening DAs were more likely to provide false-positive than false-negative rates.

CONCLUSIONS

The review led us to be concerned about completeness, balance and accuracy of information included in DAs.

Health information seeking in context: how women make decisions regarding hormone replacement therapy

This multimethod study explored women's information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Women's Health Initiative (WHI) estrogen-progestin trial results, allowing an examination of the impact of this news on women's decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45-65 who were current or former HRT users completed a questionnaire. Results indicate that women's information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.

Initiation and Discontinuation of Hormone Therapy for Menopausal Symptoms: Results From a Community Sample

Factors related to initiation and discontinuation of hormonal therapy (HT) for treatment of menopausal symptoms were examined in a community sample of 533 peri/postmenopausal women aged 45-54 by telephone three times. Over 40 variables including: sociodemographic characteristics, clinical reasons to start HT use, HT contraindications, HT attitudes/knowledge, and health behaviors were examined in logistic regression models comparing women who discontinued HT to women who continued using HT over 9 months (discontinuers) and women who initiated HT versus women who never used HT over 9 months (initiators). Increased understanding of HT, confidence, mental health symptoms, perception that menopause is natural, and having gynecological surgery were related to decreased likelihood of HT discontinuation. Increased understanding about risks of HT, vasomotor symptoms, mood symptoms, and having gynecological surgery were related to increased likelihood of HT Initiation. These findings highlight the importance of physicians discussing HT with their patients, particularly because of recent clinical trial developments.

Hormone replacement therapy: short-term versus long-term use

Midwives manage health care of women throughout the life cycle including prescribing hormone replacement therapy (HRT). This article presents a history of research on the use of HRT, as well as risks and benefits. Older research on the effects of HRT on heart disease, osteoporosis, and breast cancer is included. The results and recommendations of the Women's Health Initiative are examined.

What is this thing called hormone replacement therapy? Discursive construction of medication in situated practice

The use of hormone replacement therapy (HRT) involves complex decisions for mid-aged women owing to controversy about the meaning of menopause and uncertainty regarding risks and benefits. Qualitative studies show that women can hold apparently contradictory beliefs, for example, both resisting and relying on medicalization. Focus group data (48 participants) and discourse analysis theorizing were used to investigate the complex discursive field available to women to construct HRTand to explain apparent contradictions. Interpretative repertoires identified in this study (threatening change, natural, biomedical, and drug) support previous findings. It is not contradictory to use different repertoires to achieve different discursive acts. The application of these findings to the development of decision tools that help women to arrive at individually appropriate decisions is discussed.

Weighing the cons and pros: women's reasons for discontinuing hormone replacement therapy

As a greater proportion of U.S. women move into midlife, there has been increased interest in meeting their preventive health needs. Although hormone replacement therapy (HRT) may not be an option for all postmenopausal women, it has been documented as prolonging life expectancy and protecting against osteoporosis. Despite its advantages for many women, often those who initiate HRT discontinue its use within a short time. The purpose of this qualitative study is to gain insights into women's reasons for discontinuing HRT. We collected data by semistructured interview from three diverse samples: 10 women who had been on HRT for two years or less, 11 health care providers of women, and 34 women who had gone off HRT. Reasons for discontinuing fell into seven broad categories: general Gestalt, somatic complaints, mind (knowledge, emotion), not being heard, hassles, indecisive medical community, and cons outweighed pros. Results indicate that women who discontinue HRT do so for a variety of reasons, many of which are connected to the health care system and its providers. Outcomes also suggest that sharing in decision making along with increased education, support, and individualized care are necessary to better address the preventive health care needs of postmenopausal women.

Women's decision making regarding hysterectomy

OBJECTIVE

To describe the decision-making process of women who choose hysterectomy for treatment of benign disease or distressing symptoms.

DESIGN

Qualitative design based on grounded theory, using semistructured interviews.

SETTING

Participants were interviewed in their homes or at their place of employment.

PARTICIPANTS

Ten women who were premenopausal prior to hysterectomy.

RESULTS

Decision making began when the women recognized abnormal body changes or bothersome symptoms. Four major processes were identified. "Seeking Solutions" was characterized by information seeking, information processing, and utilization of pharmacologic and nonpharmacologic treatments in an attempt to cure the disease and/or alleviate symptoms. "Holding On" included managing symptoms, rearranging activities of daily living to accommodate symptoms, and waiting. "Changing Course" was characterized by an abrupt change from Holding On to focusing on hysterectomy as the solution to the distressing symptoms. During "Taking Charge," the women displayed purposeful actions directed at arranging and preparing for surgery.

CONCLUSIONS

Understanding the process of decision making will enable nurses to provide support for women who choose hysterectomy for treatment of benign gynecologic diseases and/or distressing gynecologic symptoms. Nurses' support of women's decision making should include referrals, education, and emotional support. In addition, nurses can help these women improve their quality of life by assisting them with symptom management.

Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies

Researchers have increasingly turned to mixed-method techniques to expand the scope and improve the analytic power of their studies. Yet there is still relatively little direction on and much confusion about how to combine qualitative and quantitative techniques. These techniques are neither paradigm- nor method-linked; researchers' orientations to inquiry and their methodological commitments will influence how they use them. Examples of sampling combinations include criterion sampling from instrument scores, random purposeful sampling, and stratified purposeful sampling. Examples of data collection combinations include the use of instruments for fuller qualitative description, for validation, as guides for purposeful sampling, and as elicitation devices in interviews. Examples of data analysis combinations include interpretively linking qualitative and quantitative data sets and the transformation processes of qualitizing and quantitizing.

Determinants of the intention to adopt hormone replacement therapy among premenopausal women

OBJECTIVE

To identify the psychosocial factors that influence the intention to adopt hormone replacement therapy (HRT) at menopause.

METHODS

Random Digit Dialing was used to recruit 644 premenopausal non-hysterectomized women aged 45-54. Data were collected using a telephone questionnaire previously developed according to the theory of planned behaviour. Variables measured were: intention to adopt HRT (INT); attitude towards HRT (Aact); perceived social norm (SN); perceived behavioural control (PBC); and personal normative belief (PNB). Socio-demographic data were also obtained.

RESULTS

Stepwise multiple regression of INT on the theoretical variables yielded an R(2) of 0.70. The determinants were Aact (beta=0.39, P<0.001), PNB (beta=0.25, P<0.001), PBC (beta=0.23, P<0.001) and SN (beta=0.12, P<0.001). Women with a strong intention to adopt HRT represented 25% of the sample. These women were more likely to believe that adopting HRT would have the following positive consequences: an improvement in general well-being, the prevention of health problems, an improvement in interpersonal relationships, an increase in productivity, the regulation of mood swings and a reduction of hot flashes. They were also more likely to believe in the following negative consequences: side-effects, an increased risk of cancer, the likelihood of weight gain, and interference in the natural course of menopause (all at P<0.001).

CONCLUSION

Actions that target behaviourial beliefs regarding HRT and perceived barriers to its adoption are most likely to influence adoption of HRT.

Women's approaches to decision making about mammography

Health professionals have an obligation to understand women's decision making about mammography and to advocate for their active participation in health care decision making. Although mammography is a major screening measure for the second largest cancer killer of women, only approximately half of women older than age 50 years, and fewer older than age 70 years, undergo mammography in accordance with American Cancer Society (ACS) guidelines. Therefore, the purpose of this study was to identify women's overall decision-making approaches when considering mammography. Subjects were a purposive, convenience sample of 50 women in the community who had made a decision about mammography; they included those who chose to have mammograms and those who decided not to have mammograms according to the pre-1997 ACS guidelines. Subjects participated in audiotaped interviews. Results indicated that women approached the mammography decision differently, regardless of the decision they made. Three overall decision-making approaches to addressing risk factors, issues about mammography, or other factors before their decision were evident. The approaches were (1) thoughtful consideration; (2) cursory consideration; and (3) little or no consideration. Each approach has implications for nurses who assist women in making decisions about mammography.

Explaining women's intentions and use of hormones with menopause

The purposes of this theoretically-based study were (a) to examine the contributions of psychosocial variables (i.e., affect, beliefs, and norms), habit, and facilitating conditions to explaining women's intentions and use of hormones with menopause and (b) to assess whether clinical or demographic factors explained intentions and use, when controlling for psychosocial, habit, and facilitating conditions variables. In a cross-sectional design, 184 pre-, peri-, and postmenopausal women completed questionnaire measures. To explain intentions, data from 124 participants who were not using hormones were analyzed. To explain use, data from 125 peri- and postmenopausal participants were analyzed. In multivariate analyses, anxiety was associated inversely with use; norms were associated positively with intentions and use. Age was associated inversely with intentions; hot flashes were associated inversely with use. Future researchers can examine the combined influences of affect, beliefs, and norms on decisions about hormones. Clinicians can address anxieties and assess social influences about hormone use, as well as offer ways to deal with hot flashes.

Predictors of quality of life in women: hormone therapy self-efficacy and health-promoting behaviors

Osteoporosis and coronary heart diseases (CHD) are two major health problems that affect postmenopausal women. The literature emphasizes that prevention of osteoporosis and/or CHD through the practices of health-promoting behaviors and hormone therapy usage can improve quality of life (QOL) for women. The purpose of this study was to examine the impact of health-promoting behaviors and hormone therapy self-efficacy on QOL. The sample contained 210 women between the ages of 45 and 84 years of age, who completed three instruments developed specifically for this study. The majority of the participants perceived moderate satisfaction with their life as a whole, performed many health-promoting behaviors, and perceived slight confidence in their ability to continue hormone therapy. Among current users of hormones, hormone therapy self-efficacy beliefs explained 31% of the variance in QOL. Among non-users of hormones, health-promoting behaviors explained 7% of the variance in QOL. In the entire sample, health-promoting behaviors explained 10% of the variance in QOL. There were significant differences between current users of hormones and non-users of hormones in QOL and in health-promoting behaviors. The study has implications for intervention and for future research.

Nurses' judgments regarding seclusion and restraint of psychiatric patients: a social judgment analysis

Clinical judgment of psychiatric nurses was investigated using judgment analysis within the framework of social judgment theory. Nine nurses at a short-term psychiatric care facility made recommendations concerning restraint and seclusion for 80 patients described on paper in terms of 17 characteristics (cues). Nurses generally favored close observation of patients over seclusion and restraint, and information about current behavior and functioning had more impact on nurses' judgments than did patient history. Nurses had good insight into the nature of their own judgments. However, individual differences in cue utilization and inconsistency in strategy usage led to disagreement among nurses about specific recommendations for particular patients. No one patient received identical recommendations from all nurses, and nurses agreed with each other on specific recommendations only about a third of the time. The lack of agreement has implications for development of staff training programs and further research on the clinical judgment processes of nurses.

The hormone replacement therapy self-efficacy scale

This study describes the initial development and psychometric evaluations of an instrument to measure self-efficacy in hormone replacement therapy (HRT) use. The development of the scale was based upon Bandura's self-efficacy construct. The sample was 116 women who were 50 years old and above and who were current or past users of HRT. Factor analysis was used to develop construct validity and Cronbach's alpha was used to compute reliabilities. Factor analysis isolated two factors, efficacy beliefs in HRT (EBs-HRT) and outcome expectations in HRT (OEs-HRT). The developed tool contains 14 items, eight items compose the EBs-HRT subscale and six items make-up the OEs-HRT subscale. The two subscales and total instrument were found to have good internal reliabilities. Implications for HRT intervention using the developed tool are discussed.

Identifying health status and health risks of older rural residents

Older rural residents are vulnerable in both health status and access to health services. This descriptive study was designed to assess the general health status and risk factors of older rural residents age 65 and over. Cluster analysis methods were used to group older adults into unique clusters of individuals with similar health risks. Although strategies are generally targeted at those with limitations in two or more activities of daily living, community health nurses might need to initiate interventions much earlier. Findings of this study can help community health providers, policymakers, and administrators strategically plan to meet the health care needs of various groups of at-risk older rural populations.

Hormone replacement therapy: determinants of women's decisions

Hormone replacement therapy: determinants of women's decisions. The purpose of this qualitative study was to explore the decision-making process used by menopausal women initiating or remaining on hormone replacement therapy (HRT), stopping HRT, or never starting HRT. Eight focus groups, composed of women reflecting these categories, were conducted. Four major themes or spheres of influence emerged as important in the women's decision-making process: the woman's internal influence--the interface between her perceptions and feelings including the symptoms of menopause, the benefits realized by HRT usage, and the experiences of negative side effects; interpersonal relationships, including the patient-physician relationship, family, friends and information networks; external influences, such as ageism and sexism; and consequences resulting from whichever treatment decision was chosen. A new concept was elucidated called "weighted influence" to underscore the dynamic interplay among the spheres. As information about HRT continues to grow and change, an understanding and application of these spheres of influence can assist physicians in engaging in a dialogue with their patients that allows individual evaluation and application of this new information.

Risks and benefits of coronary angioplasty: the patients perspective: a preliminary study

OBJECTIVES

To describe what cardiac patients in Northern Ireland understand to be the benefits of coronary angioplasty and assess the extent to which they have been able to make informed choices about their treatment.

DESIGN

An interview based questionnaire survey completed after the patients had undergone coronary angiography, within hours of treatment counselling.

SUBJECTS

150 patients consecutively recruited from two regional cardiology centres in Belfast, Northern Ireland.

MAIN OUTCOME MEASURES

The perceived complication rate and the perceived gain in life expectancy from coronary angioplasty.

RESULTS

Although most subjects had asked the consultant questions, 70% (n = 104) thought that they contributed negligibly or not at all to the treatment decision. Although 75% (n = 112) recalled discussing the complication rate from the procedure, only 27% accurately estimated this rate (as between 0.5 and 1.5%). Eighty eight per cent (n = 131) thought that their mortality risks would be substantially or greatly reduced by having the procedure. The patients anticipated a gain in life expectancy of some 10 years (median) and this was significantly in excess of the potential gain in life expectancy which dietary prudence to lower blood cholesterol, not smoking, and taking more exercise might produce (median 5 years respectively; P < 0.0001, Wilcoxon matched pairs signed rank test).

CONCLUSIONS

Patients vastly overrate the capacity of angioplasty to control their disease: angioplasty is seen as more effective than risk factor modification.

Women's beliefs and decisions about hormone replacement therapy

To examine preventive health practices in older women, we conducted computer-assisted telephone interviews with 1082 women aged 50-80 who were enrollees of Group Health Cooperative of Puget Sound (June-November 1995; 80.3% response rate). We sought to describe the women's reasons for initiating, discontinuing, or not initiating hormone replacement therapy (HRT). HRT use was categorized as current (42.5%), past (20.9%), or never (36.6%) based on the interviews. The reasons most frequently cited by current users for initiating HRT were menopausal symptoms (47.3%), osteoporosis prevention (32.4%), and physician advice (30.3%). The most frequently cited reasons for quitting HRT were side effects (26.6%), physician's advice (22.9%), fear of cancer (15.4%), and not wanting menstrual periods or bleeding (15.2%). Of past users, 53.8% reported stopping HRT on their own, and 46.2% did so at their physician's advice. The reasons most commonly cited by never users for not initiating HRT were that hormones were not needed (49.9%) and that menopause is a natural event (17.9%). Among never users, 33.1% reported considering HRT, only 46.6% discussing it with their provider, and 5.0% being given an HRT prescription they did not fill. Many women made decisions about HRT independent of interactions with health care providers. Better understanding of the beliefs and decisions that influence women's choice to use or not use HRT is needed to develop more effective counseling strategies.

Menopausal hormone therapy: physician awareness of patient attitudes

BACKGROUND

Physicians need to be aware of their patients' attitudes toward menopause when counseling women regarding hormone therapy, because menopausal attitudes may affect women's satisfaction with their decisions to use or not to use hormone therapy. Our objectives were to assess physician awareness of patient attitudes on issues surrounding the menopause and hormone therapy, and to determine the prevalence and correlates of hormone use.

METHODS

This cross-sectional survey study was conducted in the primary care outpatient practices of an academic medical center. Surveys were simultaneously administered to female patients aged 50 to 70 years (n = 182) and their primary care physicians immediately after clinical encounters. The surveys contained questions from four established (five-point) attitudinal scales (autonomy, desire for information, philosophy of the menopause, barriers to use of hormone therapy), and questions addressing patients' degree of concern about developing various conditions. Physicians were asked to estimate their patients' attitudes.

PATIENTS AND METHODS

Physicians were generally aware of patients' desire for autonomy (3.2 versus 3.2, P = 1.0), but tended to underestimate patients' desire for information (3.7 versus 4.5, P = 0.0001) and patients' perceptions of barriers to using hormone therapy (3.2 versus 3.4, P = 0.0001). They also underestimated the extent to which patients view menopause as a medical problem (3.0 versus 3.2, P = 0.0001). Physicians overestimated patients' general concern about heart disease (scale difference 0.40, P = 0.0001) and breast cancer (difference 0.23, P = 0.02). Physicians were less aware of their patients' attitudes when they were male (versus female), interns/residents (versus faculty/fellows), and less knowledgeable about menopausal hormone therapy (versus more knowledgeable). The significant predictors of hormone use on multivariate analysis were past hysterectomy, urinary incontinence, alcohol intake, and possession of knowledge regarding hormone therapy.

CONCLUSIONS

Physicians incorrectly estimate some aspects of their patients' attitudes regarding menopause and hormone therapy, and certain physician characteristics may be associated with decreased awareness. To optimize hormone therapy counseling, physicians may need to increase their attention to patients' menopausal attitudes.

Menopause: life event or medical disease?

Women throughout the world experience menopause, but it is often difficult to determine what it means and how it is perceived by women. A dilemma exists as to whether menopause should be medicalized or treated as a normal life event. The effects of this decision on the woman and the role of the advanced practice nurse in assisting the woman through this time of change are presented.

Nursing research reframed by the inescapable reality of practice: a personal encounter

This paper describes how an innocent venture outside the confines of academia to update my nursing skills completely changed the focus of my research. I was deeply involved in the theoretical development of my thesis, which I thought was a feminist exploration of the meaning of health for mid-life women. I was immersed in feminist theory and was exploring the work of the French Feminists. I had written comprehensive draft chapters about nursing, women's bodies and science. While I was absorbed in my theoretical exploration I decided to venture back into practice to improve my nursing skills. I am still unsure why I chose to do this; however, in hindsight, my theoretical exploration was inexorably pushing me in that direction. While my conscious thinking was focused on my stated topic, my subconscious (my intuition) turned me towards another. Being confronted with the reality of nursing practice through working with staff nurses in a gynaecological ward caused a major disjunction in every aspect of my research: the topic, my methodology and the setting, and the experience challenged my feelings about nurses and nursing. This inevitably led to a dramatic and fundamental change in my research.

Menopause and hormone using experiences of Chinese women in Taiwan

The purpose of this study was to explore the menopause experiences of Chinese women in Taiwan. Six hundred and seventy-three women, aged 40 to 60 years, in the Taipei metropolitan area were chosen as the sample. These women were categorized into four groups in terms of their menopausal experiences: surgical menopause, natural menopause, perimenopause, and premenopause. The results show that the three most frequently reported discomforts that women experienced during menopause were backache/lumbago, amentia, and tiredness. The frequency of reported discomforts was low compared with frequencies reported in Western countries. The surgical group reported higher rates of symptoms than others. In addition, the hormone use rate was 13.5% for the natural menopause group, 34.4% for the surgical menopause group, 12% for the perimenopause group, and 1.9% for the premenopausal group. Higher hormone use rates were inconsistent with the general negative attitudes toward hormone use in Chinese society. Among those 59 women ever using hormones, only one third reported improvement in their symptoms. Women in Taiwan have an inadequate knowledge of menopause. Further health care education and research are needed.

Clinical outcomes and mortality after hip fracture: a 2-year follow-up study

The aim of this study was to evaluate the burden of hip fractures, which occurred in the French region of Picardie, in 1992, among 1103 women and 356 men, whether the fractures occurred at home or in a community (i.e., patients who depended on a collective service). The data are part of the PICAROS study, which was designed to assess prospectively the outcome of patients as judged by clinical, economical, and quality of life factors. Patients and/or proxies were questioned during the 2nd or 3rd week following the fracture, and again at 3, 6, 12, and 24 months after the fracture. The survey was conducted by home interview. Recruitment criteria were: 1) all patients with a hip fracture as defined by the International Classification of Disease (ICD); 2) 20 years of age and over; 3) admitted to one of the 34 surgical units from the region, public and private, and had an operation or not. Patients with metastatic or myelomatous fractures or fractures on prothesis device were not included. For the present analysis, patients under 50 years of age were excluded. Among people aged 50 years and over, 3% of the general population lived in a community; 32% of hip fractures were from a community. Patients in a community, aged 60-69, had 15 times more risk of having a hip fracture than subjects of the same age at home. The excess risk decreased with age and stabilized over 85 years of age at two to threefold. During the 24 month follow-up, 394 women and 173 men died. Among those surviving, 87% were interviewed at 2 years. We analysed seven classes of complications, according to the ICD: (1) pressure sores and blisters; (2) pulmonary infections; (3) urinary infections; (4) surgical complications; (5) orthopedic complications; (6) thrombosis and embolisms; and (7) secondary hip fractures. Patients coming from a community had a higher risk of mortality, pressure sores, surgical complications, and pulmonary and urinary infections. From an economical perspective, the institutionalized population would seem to be a profitable target for the prevention of fractures and their complications.

A nurse's guide to hormone replacement therapy

Menopause is a natural event most women experience as they enter their 5th decade. As human life expectancy has lengthened, health issues concerning women in mid-life have become a major focus in holistic, preventive health care, which is heavily influenced by nurses. Controversy continues about the risks and benefits of hormone replacement therapy for women during their years of perimenopause and postmenopause. Evidence is compiling, however, that indicates the benefits of exogenous hormones may outweigh these concerns. As nurses, we must have a current knowledge of hormone replacement therapy to counsel our patients effectively. This article presents information to assist the nurse in meeting this goal.

Patient satisfaction with health care decisions: the satisfaction with decision scale

Patient satisfaction measures have previously addressed satisfaction with medical care, satisfaction with providers, and satisfaction with outcomes, but not satisfaction with the health care decision itself. As patients become more involved in health care decisions, it is important to understand specific dynamics of the decision itself. The Satisfaction with Decision (SWD) scale measures satisfaction with health care decisions. It was developed in the context of postmenopausal hormone-replacement therapy decisions. The six-item scale has excellent reliability (Cronbach's alpha = 0.86). Discriminant validity, tested by performing principal-components analysis of items pooled from the SWD scale and two conceptually related measures, was good. Correlation of the SWD scale with measures of satisfaction with other aspects of the decision-making process showed the SWD scale was correlated most highly (0.64) with "decisional confidence," and least with "desire to participate in health care decisions" and "satisfaction with provider." The SWD scale predicts decision certainty in this study. Use in an independent study showed that the SWD scale was correlated with the likelihood of patients' intentions to get a flu shot. Further investigation in relation to other health decisions will establish the utility of the SWD scale as an outcome measure.

Menopausal women as decision makers in health care

The findings of a preliminary analysis of data from a study now being conducted to design and evaluate an educational intervention to aid women in becoming more effective decision-makers regarding menopause, self-care strategies, and hormone replacement therapy (HRT), indicate that the lack of attention to the symptoms and health effects of menopause has resulted in frustration and dissatisfaction among women health care consumers. Women in the menopausal years are not informed adequately nor empowered to participate in decision making around issues related to their own health. They do not have the information they want and they do not know where to get it.

Menopause--challenges for future research

Menopause is a transition in women's lives with biological, personal, social, and cultural dimensions that together influence women's health. Scientists have not yet integrated the perspectives of multiple disciplines to provide a full account of women's experiences. Studies are underway to assess the effects of hormonal therapies used to treat symptoms that may be related to menopause or to prevent future disease. These studies will provide information women need to weigh the benefits and risks associated with hormone therapy. Although the biological dimensions of menopause warrant further study, the behavioral, social, and cultural dimensions also merit further attention. Moreover, there has been limited use of integrative perspectives, and as a result, the possibilities of cultural effects on biological processes of midlife remained understudied. The concerns of women who have been invisible, e.g., women of color, need to be brought into focus. Challenges in developing or refining methods for human research lie in studies that span the traditional disciplinary boundaries to create a more complete account of menopause and health.

Judgment processes for medication acceptance: self-reports and configural information use

In the present study college student (N = 186) made judgments of the likelihood of accepting a medication for treatment of a hypothetically experienced clinical depression. Three types of information were manipulated: effectiveness of the medication for alleviating the symptoms of depression, potential side effects of the medication, and severity of depression hypothetically being experienced. The functional-measurement approach was used to examine whether self-reports are related to judgments and whether there is configurality in judging likelihood of medication acceptance. The results showed that subjects who reported different variables to be most important had predictably different effects of the variables in their judgments. There was also evidence for configural combination of information, and the nature of the configurality differed between subjects who reported Depression versus Side Effects as the most important type of information, respectively. The results show how the same information can be used differently by different individuals in making judgments, and that self-reports may reveal some important aspects of how information is used. The implications of the individual differences for health care consumer decision making and health care professionals' assessments and interventions are discussed.

Attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy among Norwegian women

In order to investigate women's attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy (HRT) 1019 women over 17 years of age constituting a representative sample of the Norwegian female population were interviewed in 1990 as part of a monthly national opinion poll (response rate 96.5%). Women's magazines proved to be the most important source of information on hormone therapy. Only in the over-45 age group were doctors mentioned frequently as information sources. A high self-assessed information level was associated with a positive attitude towards hormone therapy. Those who had obtained information from a doctor were more positive than those who had not. More than half of those who expressed an opinion believed that hormone therapy increased the risk of heart infarction, stroke, breast cancer and cancer in general. There was a strong association between a negative attitude, towards using hormones and belief in an increased risk of serious disease. The women were more positive towards the use of HRT for the prevention of osteoporosis and for postmenopausal urogenital complaints than for the alleviation of climacteric symptoms.