Brief report: Attitudes toward hormone therapy after the women’s health initiative

Brett, Allan S.; Carney, Patricia I.; McKeown, Robert E.

doi:10.1111/j.1525-1497.2005.0089.x

Cited by 14 publications

(13 citation statements)

References 20 publications

(27 reference statements)

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

Section: Resultsmentioning

confidence: 99%

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

et al. 2007

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BACKGROUND:The landmark Women's Health Initiative (WHI) Postmenopausal Hormone Therapy Trial published in 2002 showed that the health risks of combination hormone therapy (HT) with estrogen and progestin outweighed the benefits in healthy postmenopausal women. Dissemination of results had a major impact on prescriptions for, and physician beliefs about HT. No study has fully examined the influence of the widely publicized WHI on physicians' practice and attitudes or their opinions of the scientific evidence regarding HT; in addition, little is known about how physicians assist women in their decisions regarding HT. DESIGN AND PARTICIPANTS:We conducted in-depth telephone interviews with family practitioners, internists, and gynecologists from integrated health care delivery systems in Washington State (n=10 physicians) and Massachusetts (n=12 physicians). Our objectives were to obtain qualitative information from these physicians to understand their perspectives on use of HT, the scientific evidence regarding its risks and benefits, and counseling strategies around HT use and discontinuation.APPROACH: We used Template Analysis to code transcribed telephone interviews and identify themes. RESULTS:Physicians were conflicted about the WHI results and its implications. Seven themes identified from in-depth interviews suggested that the WHI (1) was a ground-breaking study that changed clinical practice, including counseling; (2) was not applicable to the full range of patients seen in clinical practice; (3) raised concerns over the impact of publicized health information on women; (4) created uncertainty about the risks and benefits of HT; (5) called for the use of decision aids; (6) influenced discontinuation strategies; and (7) provided an opportunity to discuss healthy lifestyle options with patients. As a result of the WHI, physicians reported they no longer prescribe HT for prevention and were more likely to suggest discontinuation, although many felt women should be in charge of the HT decision.CONCLUSIONS: Physicians varied in their opinions of HT and the scientific evidence (positive and negative). Whereas the WHI delineated the risks and benefits of HT, physicians reported that decision aids are needed to guide discussions with women about menopause and HT. Better guidance at the time of WHI study publication might have been valuable to ensure best practices.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2007

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“…These results are in line with other studies that report higher HT prescribing in OB=GYNs compared with primary care providers and more caution toward HT prescribing in non-OB=GYN prescribers post-WHI. 9,11,[14][15][16] Our findings may be partially explained by the differences between OB=GYN and primary care training and patient characteristics. OB=GYNs receive greater women's health training and are, thus, likely more comfortable prescribing HT.…”

Section: Lakey Et Almentioning

confidence: 77%

“…The term alternative HT has been used to describe herbal or botanical products, 13 nonconventional HT, 20,21 and HT other than conjugated estrogen=MPA. 11 We searched for other studies published from 2002 to 2010 comparing HT use between OB=GYN and primary care providers (Pubmed, February 2010). Ours is the first study, to the best of our knowledge, to include an extensive list of HT treatment options, including normal dose, oral HT, and alternate HT products, when making comparisons between the two practice types.…”

Section: Lakey Et Almentioning

confidence: 99%

“…9,10 Studies suggest that obstetrician=gynecologists (OB=GYNs) are skeptical about the WHI results and continue to prescribe HT for many women. 9,[11][12][13] The few studies that compared attitudes about HT in OB=GYNs and other providers post-WHI report that non-OB=GYN practitioners are less permissive about HT prescribing and cite more contraindications to HT use than do OB=GYN practitioners. 11,14 These studies do not include information on providers' selfreported HT prescribing and counseling or on specific HT products, as a result of the WHI.…”

Section: Introductionmentioning

confidence: 99%

“…9,[11][12][13] The few studies that compared attitudes about HT in OB=GYNs and other providers post-WHI report that non-OB=GYN practitioners are less permissive about HT prescribing and cite more contraindications to HT use than do OB=GYN practitioners. 11,14 These studies do not include information on providers' selfreported HT prescribing and counseling or on specific HT products, as a result of the WHI. We undertook the present study to gain an understanding of providers' self-reported changes in HT prescribing and counseling post-WHI, including general use and use of specific HT products, and to examine if differences exist between primary care providers and OB=GYNs or between providers practicing in healthcare systems in different regions of the United States.…”

Section: Introductionmentioning

confidence: 99%

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Self-Reported Changes in Providers' Hormone Therapy Prescribing and Counseling Practices After the Women's Health Initiative

Lakey

Reed

LaCroix

et al. 2010

Journal of Women's Health

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Background: Prescribing and counseling practices in hormone therapy (HT) since publication of the Women's Health Initiative (WHI) trials have changed. Our objective was to compare changes by practice field and region. Methods: Between December 2005 and May 2006, we mailed surveys to 938 practitioners from two large integrated health systems in the Northeastern and Northwestern United States. We received 736 responses and excluded 144 who do not prescribe=counsel about HT, leaving 592. Data included prescriber characteristics, knowledge about HT trials, and self-reported HT counseling and prescribing changes. We compared provider characteristics and HT counseling and prescribing by region and practice field (obstetrician=gynecology [OB=GYN] or primary care). Results: Respondents included 79 OB=GYNs and 513 primary care providers. OB=GYNs were more likely, than primary care providers to consider themselves experts regarding the Heart and Estrogen=progestin Replacement Study (HERS) and WHI trials (30.4% vs. 8.2%, p < 0.001). The majority (87%) were cautious about HT use, especially primary care providers ( p < 0.01 compared to OB=GYNs). Respondents reported prescribing less oral unopposed estrogen (64%) and combination estrogen=progestin (81%) post-WHI. OB=GYNs were less likely to report decreases in oral unopposed estrogen use ( p ¼ 0.006). Use of lower-dose and transdermal products (lowdose estrogen, vaginal estrogen, estradiol vaginal ring) increased, especially by OB=GYNs. Conclusions: Our study highlights numerous HT prescribing and counseling differences between primary care and OB=GYN providers. Reasons for these differences are unknown but may be related to self-reported WHI=HERS knowledge. HT formulations used in the WHI trials are being replaced by low-dose and alternate formulations. Studies to support this practice are needed.

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Physicians' and Women's Views on Hormone Therapy and Breast Cancer Risk After the WHI: A Qualitative Study

Nekhlyudov

Bush²,

Bonomi

et al. 2009

Women & Health

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Brief report: Attitudes toward hormone therapy after the women’s health initiative

Cited by 14 publications

References 20 publications

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

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

Self-Reported Changes in Providers' Hormone Therapy Prescribing and Counseling Practices After the Women's Health Initiative

Physicians' and Women's Views on Hormone Therapy and Breast Cancer Risk After the WHI: A Qualitative Study

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