Women find physician guidelines on estrogen replacement therapy are lacking

Harvard Pilgrim Health Care's Harvard Medical School study shows women's concerns are not addressed

According to a study published in the August 17th edition of the Annals of Internal Medicine, physician guidelines are woefully inadequate in helping physicians counsel women in their decision-making process about whether to take postmenopausal estrogen replacement therapy. Based on their findings, the study's authors say that future guidelines should instruct physicians to incorporate patients' perspectives into the counseling process.

Currently, the American College of Physicians, American College of Obstetrics and Gynecology and the U.S. Preventive Services Task Force publish guidelines that recommend that caregivers counsel patients about the risks and benefits of therapy. All recommendations incorporate the best epidemiological evidence for hormone replacement therapy; however, they do not reflect the counseling needs expressed by patients.

For this study, Maureen T. Connelly, MD, and other researchers at the Department of Ambulatory Care and Prevention, a joint department of Harvard Pilgrim Health Care and Harvard Medical School, conducted indepth interviews of 26 women who had received a prescription for hormone replacement therapy. The women identified, on average, 15 factors as critical to their decision-making. The predominant influencing factors include: health care provider opinion, (96%); what media said was important, (81%); experiences and opinions of friends, (77%); and fear of breast cancer, (77%).

"Our findings support several studies that point to a substantial dissatisfaction with the decision-making process," Connelly said. "Admittedly, this is a complex issue; however, greater information about what the patient is thinking may help clinicians structure the time they spend and the materials they provide to patients. It is our hope that future recommendations incorporate the patients' perspective."

The study was funded in part by the National Institutes of Health, Harvard Pilgrim Health Care and Consumer Value Stores, Inc.