Trial of an individualized menopause decision aid

Being aware of the health risks associated with treating menopausal symptoms might only make it harder for women to decide what to do.

Yet according to a recent study, knowing how these risks relate to a woman's own health issues and personal lifestyle choices can make the decision much easier.

“Without understanding your personal risks, it can be a bewildering choice,” said Nananda Col, M.D., lead study author. “People tend to make choices based on the last spectacular headline they saw. For example, the increased risk of heart attack when taking combination hormone replacement therapy is true, but how big that risk is — compared to how big the benefit will be — is substantially different for every woman.”

Col, director of the Center for Outcomes Research and Evaluation, Maine Medical Center in Portland, and her colleagues looked at whether structured “decision aids” helped give women needed guidance. The study appears in the latest issue of the journal Medical Decision Making .

The 145 study participants received a personalized 35- to 50-page printed decision aid two weeks before a health care appointment. The women filled in response items on symptoms, lifestyle, personal history and family history. The clinics then added information on the patient's cholesterol level, blood pressure, body mass index and bone density. The researchers used these variables to generate risk estimates, screen for common conditions and provide tailored feedback.

The decision aids improved communication between doctors and patients, the study found. Forty-two percent of the women in the intervention groups felt the decision aids helped them identify questions to ask their doctors, compared with 8 percent in the control group, who only received generalized information. Fifty-nine percent said the decision aids helped them feel more in control of their health compared with 48 percent in the control group.

“Part of the purpose of the decision aids is to sort out the data that say, yes, you can improve osteoporosis at the cost of slightly increasing your breast cancer risk,” said Margaret Holmes-Rovner, Ph.D., a professor of health services research at Michigan State University and a visiting professor with the Center for the Advancement of Health. “This can be troubling to women. They need a way to get information that relates to their situation — to think about their own preferences and priorities and make a comfortable choice.”

Individualized decision aids can also help women become aware of other age-related health concerns.

“When a woman turns 50, it's a sea change,” Col said. “She is more at risk for cardiovascular disease, stroke and breast cancer. Screening becomes a concern and the main focus shifts away from reproductive health. We hope to transform short-term concerns such as menopausal symptoms into long-term disease prevention concerns.”

Medical Decision Making : Editor is Mark Helfand, M.D., M.P.H, at Oregon Health Sciences University at (503) 494-7800. To access current and past issues of journals published by SAGE Publications, go to https://online.sagepub.com/cgi/register?registration=FT72702.

Col NF, et al. Can computerized decision support help patients make complex treatment decisions? A randomized controlled trial of an individualized menopause decision aid. Medical Decision Making 27(5), 2007.

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