Opinion survey towards hormone replacement therapy in the prevention of coronary heart disease

Understanding physicians’ attitudes towards hormone therapy

OBJECTIVE

We sought to understand the relationship among components of residency education about hormone therapy (HT), knowledge about HT, and provider attitudes toward HT during a time of rapidly changing practice guidelines.

METHODS

We surveyed residents in the University of Pittsburgh Internal Medicine residency programs between February to April 2002 (after the release of the Heart Estrogen/Progestin Replacement Study and prior to the release of preliminary Women's Health Initiative data) regarding demographics, educational (didactic and experiential) exposures to HT and menopause management, knowledge about HT, and attitudes toward HT.

RESULTS

Sixty-nine of 92 (75%) eligible residents completed the survey; 38% were women. The race and gender of responders did not differ from nonresponders. Residents had significant didactic exposure to HT and menopause management with 80% reporting more than one didactic exposure. Despite this, HT knowledge was low (mean knowledge score 47 +/- 16%) and only 26% of residents felt prepared to counsel patients about HT. We identified four factors related to provider attitudes toward HT: "persistence" in universally recommending HT, confidence in "HT benefits," concern about "HT cardiac risks," and concern about "HT noncardiac risks." More appropriate attitudes were associated with attending a lecture, having a rotation with a discussion of menopause management (i.e., Women's Health), and a continuity practice including more than 30% women. Pharmaceutical detailing and self-directed study were associated with less appropriate attitudes. Knowledge did not influence attitudes. Strongly held beliefs about the benefits of HT, appropriate or inappropriate, were associated with increasing "persistence."

CONCLUSIONS

In an area of rapidly changing information, such as the risks and benefits of HT, knowledge is low. Experiential learning appropriately influences attitudes, while pharmaceutical detailing was associated with inappropriate attitudes toward HT risks.

Associations between attitudes toward hormone therapy and current use of it in middle-aged women

OBJECTIVES

To investigate the association between attitudes toward hormone therapy (HT) and use of it and explanatory factors for the association found.

METHODS

All women in two primary healthcare districts aged 45, 50, 55 or 60 in 2000 or 2001 (n=771) received a questionnaire consisting of quality-of-life instruments and items concerning menopause, health, healthcare, symptoms, sociodemographic factors and attitudes toward HT.

RESULTS

A total of 564 women (74%) responded to the questionnaire. In the women with a positive or a neutral attitude, rather than a negative one, the age- and menopause-adjusted odds ratios for current HT use were 18.55 (95% CI 8.55, 40.11) and 2.61 (1.15, 5.93), respectively. Health-related factors, factors concerning one's own person and psychosocial factors were the groups of factors found to contribute to explaining the association between attitudes and current HT use. Together, the three groups of factors explained 42 and 98%, respectively, of a positive and a neutral attitude's association with current use of HT. Individual factors of importance in these factor groups were a feeling of being appreciated outside the home, satisfaction with one's work, marital status, own climacteric period, visits to a physician and past use of hormonal contraceptives. In contrast, level of education and the occurrence of cold sweats/hot flushes was not found to contribute to the explanation.

CONCLUSIONS

Factors concerned with women's everyday life, contentment with oneself and use of healthcare services were of importance in explaining the associations between attitudes toward HT and current use of it. Consideration at these factors in counselling women about HT is recommended.