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Hubka TA, Crim A, Koh JY, Larrison C, McKeithen T, Fleming M, Caruso J, Prud'homme M. Uncovering gaps in management of vasomotor symptoms: findings from a national need assessment. J Osteopath Med 2024; 0:jom-2024-0011. [PMID: 38809719 DOI: 10.1515/jom-2024-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
CONTEXT This national needs assessment study explores the knowledge, attitude, beliefs, and practices (KABP) gaps related to vasomotor symptoms (VMS) associated with menopause among primary care and OB/GYN clinicians. VMS significantly impacts healthcare costs, workplace productivity, and patient psychosocial health, but a notable disconnect exists between healthcare providers and patients, with provider reticence and knowledge gaps playing a contributing role. OBJECTIVES This study aims to identify and propose optimal educational strategies to address these barriers, with attention to health disparities affecting women of color. METHODS Methods employed include a multimodal approach of literature review, expert opinion, qualitative interviews, surveys, focus groups, and case studies, ensuring diverse clinician input. Data collection involved in-depth clinician interviews, a nationally disseminated clinician survey, and focus groups. RESULTS Results indicate a critical deficiency in healthcare providers' understanding and management of VMS, especially among OB/GYN residents, with 75 % showing limited knowledge. The study also highlights the disproportionate impact of knowledge gaps on women of color, emphasizing the need for a culturally informed approach in medical training and practice. There's a notable discrepancy between clinicians' current and desired abilities in managing VMS, indicating a need for ongoing professional development. Significant variability in approaches to diagnosing and treating VMS, as well as substantial knowledge gaps about treatment options, underscore the need for evidence-based protocols. CONCLUSIONS Although VMS are a normal aspect of aging, they can significantly disrupt quality of life for many women, necessitating intervention. Beyond the immediate discomfort, VMS can impact quality of life and trigger insomnia and mood disturbances. This study exposes both new and previously recognized gaps in healthcare providers' knowledge and management skills concerning VMS treatment options, particularly regarding hormonal and nonhormonal therapies. Furthermore, our findings highlight the need for a deeper understanding of how VMS uniquely impacts women of diverse backgrounds. Research, including the Study of Women's Health Across the Nation (SWAN), suggests that the experience and severity of VMS may be influenced by socioeconomic status, race/ethnicity, body mass index (BMI), and smoking status. However, the complex interplay of these factors and their relative contributions remain unclear. Further investigation is crucial to facilitate equitable access to effective treatment for all women. To bridge these gaps, improved education starting as early as residency is essential. This education should address common misconceptions about VMS and its management. Healthcare providers must enhance their competence in discussing the broad spectrum of VMS impacts and employ effective communication strategies to ensure that patients are well-informed about their symptoms and available treatment options.
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Affiliation(s)
- Teresa A Hubka
- President-Elect, American Osteopathic Association, Chicago, IL, USA
- Chair, Department of Obstetrics and Gynecology, Midwestern University/Chicago College of Osteopathic Medicine, Chicago, IL, USA
- Founder and Medical Director, Comprehensive Wellness Care, LLC, Chicago, IL, USA
| | - Andrew Crim
- American College of Osteopathic Obstetricians and Gynecologists, Fort Worth, TX, USA
| | - Ju Yong Koh
- Obstetrician and Gynecologist, 422568 Northwestern Medicine Regional Medical Group , Chicago, IL, USA
| | - Chris Larrison
- Founding Partner, Healthcare Performance Consulting, Inc., Zionsville, IN, USA
| | - Tom McKeithen
- Founding Partner, Healthcare Performance Consulting, Inc., Fleming Island, FL, USA
| | - Matthew Fleming
- Vice President, Antidote Education Company, Nashville, TN, USA
| | - Jennifer Caruso
- Editorial Chair, American College of Osteopathic Obstetricians and Gynecologists, Troy, MI, USA
| | - Martha Prud'homme
- Senior Program Manager, American College of Osteopathic Obstetricians and Gynecologists, Fort Worth, TX, USA
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Zahn K, Pittman A, Conklin J, Knittel A, Neal-Perry G. Disparities in menopausal care in the United States: A systematic review. Maturitas 2024:108021. [PMID: 38760255 DOI: 10.1016/j.maturitas.2024.108021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
Effective menopausal care constitutes a continuum of symptom management and optimization of medical health, including cardiovascular, bone, and mental health. Menopausal knowledge and prescribing patterns changed significantly after the publication of the Women's Health Initiative. A systematic review was conducted to address three key questions about disparities in menopausal care: 1) What differences in menopausal care are experienced by specific populations? 2) What disparities are there in access to preventive care and symptomatic treatment? 3) What interventions reduce disparities in menopause management? PubMed, PsychInfo, SCOPUS, and EMBASE were queried to identify relevant articles published in the United States between 2002 and 2023. Twenty-eight articles met the review criteria; these included quantitative and qualitative analyses. Symptomatic menopausal patients utilize a range of therapies. Racial and ethnic minorities, veterans, women living with HIV, incarcerated individuals, patients with surgical menopause, and nursing home residents represent specifically studied populations that demonstrate differences in menopausal care. Healthcare professionals may impact access to certain therapeutics, possibly driven by lack of content knowledge or implicit bias. Insurance status and geographic location may also affect menopause management or access to care. Few interventions exist to address disparities in menopausal care. There is an urgent need to understand how patients and providers make menopausal treatment decisions and intervene to mitigate health disparities in menopausal care.
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Affiliation(s)
- Katelin Zahn
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Allison Pittman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jamie Conklin
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Andrea Knittel
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Vesco KK, Brooks NB, Francisco MC, Leo MC, Anderson TM, Kalter M, Clark AL. Resident training to optimize patient-focused menopause management: a multispecialty menopause curriculum to enhance knowledge and preparedness. Menopause 2024; 31:93-100. [PMID: 38166240 DOI: 10.1097/gme.0000000000002291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
OBJECTIVE Surveys of residents in obstetrics and gynecology, internal medicine, and family medicine have demonstrated low levels of knowledge and comfort in treating patients with menopausal symptoms, suggesting a need for improved training during residency. To address this problem, we used a flipped classroom design to deliver a novel menopause curriculum for medical residents. The curriculum included six podcast episodes followed by an interactive case-based classroom session. We then assessed effects of the curriculum on the residents' knowledge and preparedness to manage menopause symptoms. METHODS We targeted 200 residents (43 obstetrics and gynecology, 86 internal medicine, and 71 family medicine) from six residency programs from 2019 to 2020. Of these, 115 (58%) completed both pre- and postcurriculum assessments, including a 15-item knowledge test and self-ratings of their knowledge, comfort, and preparedness to manage menopause. RESULTS Following the curriculum, the proportion of correctly answered knowledge questions rose from 60.8% to 79.1% (+18.3%; 95% confidence interval, 15.4-21.2; Cohen's d = 1.2). Improvement did not significantly differ by specialty or year of residency. There were higher gains for residents who listened to the entirety of all six podcast episodes ( b = 11.4, P < 0.001) and who attended the classroom session ( b = 11.6, P = 0.003). Residents' self-ratings of knowledge, comfort, and preparedness also improved following the curriculum across all medical specialties (Cohen's d = 0.47-1.2). Residents rated the podcast format as convenient (73%) and effective (65%) compared with an equivalent amount of reading. CONCLUSIONS Pairing a podcast with a classroom discussion was found to be an effective combination for improving menopause knowledge.
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Affiliation(s)
| | - Neon B Brooks
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Melanie C Francisco
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Michael C Leo
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Marlene Kalter
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Allen JT, Laks S, Zahler-Miller C, Rungruang BJ, Braun K, Goldstein SR, Schnatz PF. Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause 2023; 30:1002-1005. [PMID: 37738034 DOI: 10.1097/gme.0000000000002234] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This study aimed to assess the variance in menopause education, educational resources, and the needs of obstetrics and gynecology (ObGyn) residency programs by conducting a national survey of program directors (PDs). METHODS In 2022, an institutional review board-approved Web-based Qualtrics survey was designed and distributed electronically to 145 US ObGyn residency PDs. The survey consists of 15 questions. The main outcomes are reported using descriptive statistics. RESULTS The survey was completed by 99 of 145 PDs (68.3%). Almost all participants (92.9%) strongly agreed that residents nationwide should have access to a standardized menopause curriculum that could be utilized in their programs. Only 31.3% reported having a menopause curriculum in their residency program. Of the programs with a menopause curriculum, 96.8% reported using lectures, 77.4% reported assigned readings, and 74.2% had either dedicated menopause clinics or other clinics with a high volume of menopausal patients. Of all programs surveyed, only 29.3% reported that trainees had dedicated time assigned to a menopause clinic. A total of 83 of 99 PDs agreed or strongly agreed that their programs needed more menopause educational resources, and most (89.7%) stated they were likely or very likely to use self-paced menopause modules that include performance feedback if available. CONCLUSIONS Data from the needs assessment questionnaire revealed that menopause education and resources vary across residency programs, with the majority lacking a dedicated menopause curriculum. Most PDs expressed a desire for more educational resources and standardized training materials, and preferred to access an online national menopause curriculum.
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Affiliation(s)
- Jennifer T Allen
- From the Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Shahar Laks
- From the Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | | | - Bunja J Rungruang
- From the Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Kelli Braun
- From the Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University, New York, NY
| | - Peter F Schnatz
- Department of Obstetrics and Gynecology and Internal Medicine, Reading Hospital/Tower Health & Drexel University, Reading, PA
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Macpherson BE, Quinton ND. Menopause and healthcare professional education: A scoping review. Maturitas 2022; 166:89-95. [PMID: 36095904 DOI: 10.1016/j.maturitas.2022.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There has been a growing discourse regarding menopause, but despite this growth there is little education on this important topic across health professions. This scoping review provides a comprehensive synthesis of how menopause is represented in health professions' education literature, to inform future pedagogy and practice. DESIGN A scoping review using the framework developed by Arksey and O'Malley (2005). METHODS In the scoping review, only empirical studies were considered and only those published in the English language were included. Four databases were interrogated using a variety of search terms, including menopause, healthcare, medical and education. RESULTS Twelve studies were included and mapped independently by the authors onto the internally developed data-extraction tool. Insights into how menopause is understood in educational terms and how it is taught within health professions' education were gained, specifically in relation to knowledge, language used, and learning and educational gaps. CONCLUSION The review establishes how menopause is understood in educational terms and how it is taught within health professions' education, and develops an understanding of the pedagogy of menopause. There is an urgent need for menopause to be included in mainstream curricula and for an appropriate pedagogy that acknowledges the complexity of the topic, to achieve excellence in education across health professions' education. There is a broader perspective in addressing the challenges for health professions' education in terms of the prioritisation and pedagogy of women's health.
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Affiliation(s)
- Barbara E Macpherson
- Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds LS2 9NL, UK.
| | - Naomi D Quinton
- Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds LS2 9NL, UK. https://twitter.com/drna
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Edwards AL, Shaw PA, Halton CC, Bailey SC, Wolf MS, Andrews EN, Cartwright T. "It just makes me feel a little less alone": a qualitative exploration of the podcast Menopause: Unmuted on women's perceptions of menopause. Menopause 2021; 28:1374-1384. [PMID: 34469933 DOI: 10.1097/gme.0000000000001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Menopause can negatively impact women's quality of life, with many women reporting inadequate information and support. Podcasts have grown in popularity in recent years and have been found to be accessible methods for increasing knowledge and challenging perceptions of stigmatized topics. The current research aimed to understand the impact of the podcast "menopause: unmuted" on women's menopause-related knowledge, understanding, and communication practices. METHODS A diverse sample of 30 women aged 40 to 60 years listened to the podcast series, which focused on menopause stories, before taking part in semistructured interviews to discuss the impact of the podcast on how they understood and communicated about menopause. The interviews were analyzed thematically. RESULTS Two overarching themes were identified in the data. A "journey of knowledge gain" explores participants' understanding of menopause before listening to the podcast and describes how this is deepened by hearing and connecting with women's stories. "Reframing menopause" describes the impact of the podcast, where women reflect on the value of communication amongst women, challenge and re-evaluate the stigmatization of menopause, and discuss ways to make positive behavioral changes in their lives. CONCLUSIONS The podcast "menopause: unmuted" helped women to learn about the menopause experience, have a greater sense of belonging to a community of women, and feel empowered to make changes in their own lives. Sharing stories via podcasts has potential as an accessible and impactful medium to educate women and reduce the widespread stigma associated with menopause.
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Affiliation(s)
- Amy L Edwards
- School of Social Sciences, University of Westminster, London, UK
- Studio Health, London, UK
| | - Philippa A Shaw
- School of Social Sciences, University of Westminster, London, UK
| | - Candida C Halton
- School of Social Sciences, University of Westminster, London, UK
- Studio Health, London, UK
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | | | - Tina Cartwright
- School of Social Sciences, University of Westminster, London, UK
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Harrison GM, Medley NN, Carroll KN, Simms-Stewart DA, Wynter SH, Fletcher HM, Rattray CA. Mind the gap: primary care physicians and gynecologists' knowledge about menopause and their attitudes to hormone therapy use in Jamaica. Menopause 2021; 28:1385-1390. [PMID: 34469932 DOI: 10.1097/gme.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study objective was to evaluate physicians' knowledge, attitude, and practices toward menopause and hormone therapy. METHODS This study was a cross-sectional study using a stratified sample of physicians across the four health regions in Jamaica, between September and October 2017. A total of 145 physicians (75% response rate) completed a questionnaire to assess knowledge and attitudes toward menopause and prescribing hormonal therapy. Univariate and bivariate analyses were used to describe and compare the knowledge, attitudes, and practices in participants. RESULTS The majority of physicians (66%) self-reported a moderate level of knowledge of menopausal treatment options. Self-reported knowledge was associated with years in practice (P < 0.0001) and level of experience (P < 0.0001). Those who identified as having good and moderate knowledge were likely to discuss treatment options with patients (P < 0.005), while physicians with good knowledge were more likely to prescribe hormone therapy (P < 0.05). Correct responses regarding common menopause symptoms were noted in >60% physicians; however, there was a precipitous fall in correct responses regarding findings related to the Women's Health Initiative (<45%). More consultant grade physicians were confident and less confused about prescribing hormone therapy (P < 0.05) compared to junior grade physicians. When stratified by level of experience, knowledge level was the factor that discouraged physicians from seeing symptomatic menopausal patients (P < 0.05). CONCLUSIONS This study highlights the gaps in knowledge and practices and a need for carefully designed curricula to provide individualized, risk-mitigated training in menopause healthcare.
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Affiliation(s)
- Giselle M Harrison
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Natalie N Medley
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Kamali N Carroll
- Hugh Wynter Fertility Management Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Donnette A Simms-Stewart
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Shaun H Wynter
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Horace M Fletcher
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Carole A Rattray
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
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Reid HW, Branford K, Reynolds T, Baldwin M, Dotters-Katz S. It's Getting Hot in Here: Piloting a Telemedicine OSCE Addressing Menopausal Concerns for Obstetrics and Gynecology Clerkship Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11146. [PMID: 33937522 PMCID: PMC8079425 DOI: 10.15766/mep_2374-8265.11146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Although menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit. METHODS We designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes. RESULTS Thirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value. DISCUSSION While medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.
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Affiliation(s)
- Hadley W. Reid
- Third-Year Medical Student, Duke University School of Medicine
| | - Kelly Branford
- Director of Clinical Skills Program, Office of Curricular Affairs, Duke University School of Medicine
| | - Tracey Reynolds
- Standardized Patient Coordinator, Office of Curricular Affairs, Duke University School of Medicine
| | - Melody Baldwin
- Assistant Professor, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Sarah Dotters-Katz
- Assistant Professor, Department of Obstetrics and Gynecology, Duke University Medical Center
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Facing Provider Misconceptions Towards the Use of Hormone Therapy in 2020. J Gen Intern Med 2021; 36:767-768. [PMID: 32500331 PMCID: PMC7947121 DOI: 10.1007/s11606-020-05940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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10
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Attitude, confidence and social norm of Dutch occupational physicians regarding menopause in a work context. Maturitas 2020; 139:27-32. [DOI: 10.1016/j.maturitas.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
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Bailey SC, Andrews EN, Halton CC, Wolf MS. Evaluation of a Discussion Guide to Promote Patient Understanding of Menopause and Informed Treatment Decision-Making. J Womens Health (Larchmt) 2020; 30:445-451. [PMID: 32857643 DOI: 10.1089/jwh.2020.8436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patient-provider communication surrounding menopause symptoms and treatment is often limited. We developed and evaluated a health literacy-appropriate discussion guide to support patient education. Materials and Methods: A cross-sectional randomized study was conducted among 100 English-speaking women, aged 45-60 years, in Chicago, IL, and Durham, NC. Participants were randomly assigned to review either the discussion guide or a standard education material (n = 50 per arm) and to complete an open book knowledge questionnaire; they then rated the appearance and quality of both materials. Bivariate analyses examined knowledge and satisfaction by study arm and across sociodemographic characteristics. Multivariable models tested the effectiveness of the discussion guide to improve knowledge compared with the standard material. Results: Women receiving the discussion guide demonstrated significantly higher knowledge scores compared with those who reviewed the standard material (mean [M] = 20.0, standard deviation [SD] = 2.7, vs. M = 18.1, SD = 2.6; p < 0.001); 82.0% of those exposed to the discussion guide correctly answered ≥85% of knowledge items compared with only 48.0% of those reviewing the standard material (p < 0.001). In multivariable analyses, participants receiving the discussion guide displayed significantly greater knowledge in comparison with those receiving the standard material regardless of whether knowledge was examined as a score (∝ = 1.9, 95% confidence interval [CI]: 0.9-2.9, p < 0.001) or 85% threshold (odds ratio: 5.7, 95% CI: 2.0-16.2, p < 0.001). More than two-thirds of women (68%) preferred the discussion guide; it was rated highly in terms of appearance and content. Conclusions: The discussion guide improved understanding of menopause symptoms and treatment options in comparison with a current standard and was well received by a diverse audience.
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Affiliation(s)
- Stacy Cooper Bailey
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma N Andrews
- U.S./Global Medical Affairs, Pfizer, Inc., New York, New York, USA
| | - Candida C Halton
- School of Social Sciences, University of Westminster, London, United Kingdom.,Consultant at Studio Health, London, United Kingdom
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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12
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Lin L, Feng P, Yu Q. Attitude and knowledge for menopause management among health professionals in mainland China. Climacteric 2020; 23:614-621. [PMID: 32543223 DOI: 10.1080/13697137.2020.1775809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to understand the attitude of health-care professionals (HPs) in mainland China toward menopause management (MM) as well as the knowledge they have received regarding MM during training. METHODS An anonymous survey recruited 3709 medical workers nationwide (including physicians, orthopedists, obstetricians and gynecologists, and general practitioners) through online surveys and on-site interviews at professional meetings. RESULTS Of the 3709 questionnaires completed, 3426 questionnaires met the inclusion criteria. Of the participants, 1532 HPs had not received menopause management training (MMT) in nearly 1 year. Among the residents and physician assistants, 103 reported they were not familiar with MM. Satisfyingly, 98.3% of HPs considered it very important or essential to accept MM. Although most interviewees replied some correct menopausal knowledge, nearly half of them could not correctly identify the contraindications for menopause hormone therapy (MHT). Additionally, 73.1% of HPs would advise patients with premature ovarian insufficiency to receive hormone replacement therapy at least until the average age of menopause. CONCLUSION This survey indicated that HPs have some knowledge regarding MM, but a gap remains to master the basic theory of MHT. In order to manage the growing menopausal population in China, creating more in-depth educational MMT programs for HPs is necessary.
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Affiliation(s)
- L Lin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - P Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Q Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Randomized crossover study investigating resident retention of menopause-related knowledge after completion of learning modules. ACTA ACUST UNITED AC 2019; 27:95-101. [PMID: 31567875 DOI: 10.1097/gme.0000000000001417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate residents' retention of menopause-based knowledge immediately after, and 3 months after completion of, self-administered modules that varied by menopause-related topic and delivery format. METHODS Prospective crossover study of Obstetrics and Gynecology and Family Medicine residents at one institution over the 2017 to 2018 academic year. Residents were randomized to a series of three PowerPoints (Microsoft, Redwood, WA), each <30 slides, administered during regularly scheduled didactics. Each series contained three subjects (Menopause Basics [MB], Hormone Therapy [HT], and Genitourinary Syndrome of Menopause [GSM]) delivered through three different presentation styles (typical presentation [typical], pictures and a narration [pictures], and interactive to reveal information [interactive]). Knowledge and comfort were assessed through baseline, immediate postexposure, and 3-month follow-up surveys containing 24 knowledge questions (multiple choice) and 10 comfort and satisfaction questions (5-point Likert scale and multiple choice). Statistical tests were applied with P<0.05 considered significant. RESULTS Thirty-three residents completed the 3-month follow-up. Immediately postexposure, knowledge and comfort increased from baseline for all topics (P < 0.05). When formats were grouped together to investigate retention by topic, the HT topic demonstrated a sustained increase in knowledge on 3-month follow-up (P = 0.047). The typical format of the GSM topic had significantly better retention than the picture format (P = 0.027). All formats were associated with a significant increase in comfort (all P < 0.01). CONCLUSIONS Participation in this specialized menopause curriculum led to short-term increases in objectively assessed menopause-related knowledge. Tailoring self-administered learning modules to learning styles did not, however, effectively enhance overall knowledge retention on 3-month follow-up, though comfort in managing menopause remained increased. : Video Summary:http://links.lww.com/MENO/A474.
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Abstract
Although American women spend approximately 30% to 40% of their lives in menopause, a state defined by the cessation of estrogen production by the ovaries, obstetricians and gynecologists in North America receive little formal education about menopausal health. Hormonal therapy has been available for more than 75 years; however, controversies surrounding its use have impacted training of care providers in all specialties. This article offers updates on care for menopausal women, focusing on symptomatology and health issues that arise related to the decline in all reproductive hormones. Lifestyle adaptations and nonmedical approaches, and nonhormonal and hormonal medications are discussed.
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Affiliation(s)
- Mary Jane Minkin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 40 Temple Street, Suite 7A, New Haven, CT 06510, USA.
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Clinician knowledge, attitudes, and barriers to management of vulvovaginal atrophy: variations in primary care and gynecology. Menopause 2019; 26:265-272. [DOI: 10.1097/gme.0000000000001198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Predictors of Initiating Hormone Replacement Therapy in Postmenopausal Women: A Cross-Sectional Study. ScientificWorldJournal 2019; 2019:1814804. [PMID: 30728754 PMCID: PMC6343148 DOI: 10.1155/2019/1814804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/24/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Some of the social factors were related to hormone replacement therapy. The purpose of this study is to determine hormone replacement therapy (HRT) rates and to illustrate social factors affecting hormone replacement therapy in postmenopausal women. Material and Methods This study comprised a total of 1052 postmenopausal women, 926 of whom were reported menopausal symptoms and sought for the treatment. 432 of these 926 participants had treated their symptoms by receiving HRT. The data was collected with a data collection form prepared by the researcher by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. Results The multivariate analyses indicated that the decision to seek treatment was influenced by a multitude of factors. These factors included location of hormone replacement therapy (OR: 12.32 [3.21-44.46] in university hospital and OR: 5.42 [2.43–13.26] in private hospital), information received about HRT (OR: 7.25 [2.14,-30.80]), physicians' counselling and involvement (OR: 5.24 [2.82-9.86]), knowledge of complications associated with HRT (OR: 6.21 [3.28-16.62]), and employment status (OR: 3.42 [1.86-5.58]). The current study identifies these factors affecting the HRT process in postmenopausal women. Conclusion This study suggests that although the results do not demonstrate an exhaustive list of factors affecting the HRT process, they nonetheless provide evidence that the location participants applied for, physicians' counselling and involvement, participant employment status, and knowledge surrounding HRT may affect a woman's intent to receive HRT. Therefore, these results indicate that health professional influence and HRT awareness are important for HRT use. Suggestions for health care include informing women of the advantages and disadvantages of HRT to encourage popularity.
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Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment. Menopause 2018; 25:937-949. [DOI: 10.1097/gme.0000000000001088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Thu WPP, Logan SJS, Lim CW, Wang YL, Cauley JA, Yong EL. Cohort Profile: The Integrated Women’s Health Programme (IWHP): a study of key health issues of midlife Singaporean women. Int J Epidemiol 2018; 47:389-390f. [DOI: 10.1093/ije/dyx278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Win Pa Pa Thu
- Department of Obstetrics and Gynaecology, National University of Singapore (NUS), Republic of Singapore
| | - Susan Jane Sinclair Logan
- Department of Obstetrics and Gynaecology, National University of Singapore (NUS), Republic of Singapore
| | - Chun Wei Lim
- Department of Obstetrics and Gynaecology, National University of Singapore (NUS), Republic of Singapore
| | - Yue Luna Wang
- Department of Obstetrics and Gynaecology, National University of Singapore (NUS), Republic of Singapore
| | - Jane A Cauley
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - E L Yong
- Department of Obstetrics and Gynaecology, National University of Singapore (NUS), Republic of Singapore
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De Giovanni JM, Tapley A, Druce PL, Davey AR, van Driel ML, Henderson KM, Catzikiris NF, Mulquiney KJ, Morgan S, Spike NA, Kerr RH, Magin PJ. GP registrar consultations addressing menopause-related symptoms: a cross-sectional analysis. Menopause 2017; 25:563-570. [PMID: 29257032 DOI: 10.1097/gme.0000000000001042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the prevalence and associations of general practitioner registrars' (trainees') management of women with menopause-related symptoms. METHODS A cross-sectional analysis from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. In ReCEnT registrars collected data of 60 consecutive consultations on three occasions during training. The outcome factor was menopause-related problems/diagnoses (compared with other problems/diagnoses). Associations of registrar, patient, practice, and consultation-independent variables were assessed by univariate and multivariable logistic regression. RESULTS In all, 1,333 registrars conducted 189,774 consultations involving 295,017 problems/diagnoses. Of these, there were 1,291 problems/diagnoses (0.44% of all problems/diagnoses) relating to menopause. Significant multivariable independent associations of a problem being menopause-related were registrar female sex (odds ratio [OR] 2.74, 95% confidence interval [CI] 2.30-3.26) and registrars working part-time (OR 0.84, 95% CI 0.72-0.98 for full-time work). Consultation-related associations included an increased number of problems addressed in the consultation (OR 1.29, 95% CI 1.21-1.37), and menopause-related problems/diagnoses not being new (OR 0.75, 95% CI 0.66-0.86). Significant educational associations were increased odds of recourse to in-consultation sources of information or assistance (OR 2.09, 95% CI 1.80-2.44) and of generating learning goals (OR 3.15, 95% CI 2.66-3.72). CONCLUSIONS Registrars seek more assistance and further knowledge about menopause compared with other problems. Thus, they may find the area particularly challenging and could benefit from further education regarding managing menopause. Our findings may help inform the design of measures aimed at improving the delivery of menopause training for general practice registrars.
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Affiliation(s)
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle
| | - Penny L Druce
- GP Synergy General Practice Regional Training Organisation
| | - Andrew R Davey
- School of Medicine and Public Health, University of Newcastle
| | - Mieke L van Driel
- Discipline of General Practice and Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland
| | - Kim M Henderson
- School of Medicine and Public Health, University of Newcastle
| | | | | | - Simon Morgan
- GP Synergy General Practice Regional Training Organisation
| | - Neil A Spike
- Eastern Victoria GP Training, Department of General Practice, University of Melbourne
| | | | - Parker J Magin
- School of Medicine and Public Health, University of Newcastle
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Yeganeh L, Boyle J, Teede H, Vincent A. Knowledge and attitudes of health professionals regarding menopausal hormone therapies. Climacteric 2017; 20:348-355. [DOI: 10.1080/13697137.2017.1304906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- L. Yeganeh
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menopause Unit, Monash Health, Melbourne, Victoria, Australia
| | - H. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
- Monash Partners Academic Health Sciences Centre, Melbourne, Victoria, Australia
| | - A. Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menopause Unit, Monash Health, Melbourne, Victoria, Australia
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Effectiveness of a 2-year menopause medicine curriculum for obstetrics and gynecology residents. Menopause 2016; 23:275-9. [DOI: 10.1097/gme.0000000000000531] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Resident education in menopause. Menopause 2016; 23:241-2. [DOI: 10.1097/gme.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Minkin MJ. Sexual health and relationships after age 60. Maturitas 2016; 83:27-32. [DOI: 10.1016/j.maturitas.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 01/09/2023]
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Foreman H, Weber L, Thacker HL. Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation. J Womens Health (Larchmt) 2015; 24:336-40. [PMID: 25884348 PMCID: PMC4440992 DOI: 10.1089/jwh.2014.5187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While Women's Health (WH) Fellowships have been in existence since 1990, knowledge of their existence seems limited. Specialized training in WH is crucial to educate leaders who can appropriately integrate this multidisciplinary field into academic centers, especially as the demand for providers confident in the areas of contraception, perimenopause/menopause, hormone therapy, osteoporosis, hypoactive sexual desire disorder, medical management of abnormal uterine bleeding, office based care of stress/urge incontinence, and gender-based medicine are increasing popular and highly sought after. WH fellowship programs would benefit from accreditation from the American Board of Medical Subspecialties and from the American College of Graduate Medical Education, as this may allow for greater recruitment, selection, and training of future leaders in WH. This article provides a current review of what WH trained physicians can offer patients, and also highlights the added value that accreditation would offer the field. Ultimately, accrediting WH fellowships will improve women's health medical education by creating specialists that can serve as academic leaders to help infuse gender specific education in primary residencies, as well as serve as consultants and leaders, and promote visibility and prestige of the field.
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Affiliation(s)
- Heather Foreman
- Department of Internal Medicine, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
- Center for Specialized Women's Health, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Weber
- Center for Women's Health, A NorthBay Affiliate, Fairfield, California
| | - Holly L. Thacker
- Center for Specialized Women's Health, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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Santen RJ, Stuenkel CA, Burger HG, Manson JE. Competency in Menopause Management: Whither Goest the Internist? J Womens Health (Larchmt) 2014; 23:281-5. [DOI: 10.1089/jwh.2014.4746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Richard J. Santen
- Division of Endocrinology and Metabolism, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Cynthia A. Stuenkel
- Division of Endocrinology, Diabetes and Metabolism, University of California at San Diego, La Jolla, California
| | - Henry G. Burger
- Prince Henry's Institute for Medical Research, Monash University, Melbourne, Australia
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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