Public Release: 

Individualized educational materials help women decide about hormone replacement therapy

Duke University Medical Center

DURHAM, N.C. -- A new study shows that individually tailoring educational materials about hormone replacement therapy (HRT) can help menopausal women better understand the pros and cons of taking HRT and feel more confident about their decision whether or not to undergo the therapy. These decision aids could be posted on the Web or distributed in clinics to assist women before clinical appointments to make better use of limited visit time.

The study is published in the July 2002 issue of the American Journal of Public Health.

The rapidly changing knowledge about HRT, as well as the increased number of women entering menopause, requires innovative and flexible modes of communication about HRT, said the researchers who conducted the study. The decision of whether or not to use HRT can be a complex issue and may require considerable education and counseling, which can take a significant amount of time in an already short health care visit.

The debate over the relationship between HRT and disease revolves around the fact that the therapy might reduce the risk of osteoporosis and improve quality of life. However, it also carries a possible increased risk of breast cancer and may cause heart problems in women with a history of heart disease.

"HRT is a controversial topic, and there is no one answer that's right for all women," said co-author Ilene Siegler, Ph.D., professor of psychiatry at Duke University Medical Center.

According to study co-author Colleen McBride, Ph.D, most information on HRT talks about general health risks and benefits for women, but doesn't directly address an individual woman's risk for breast cancer or her potential benefits from HRT.

"We wanted to see if customizing educational materials about HRT would personalize risk versus benefit in a way that would help women feel confident about their decision," said McBride, who is an associate professor of community and family medicine at Duke University Medical Center and director of the Cancer Prevention, Detection and Control Program at Duke Comprehensive Cancer Center.

In the study, 581 Durham County (North Carolina) women ages 45 to 54 were surveyed by phone. The women agreed to receive written materials about HRT and did not have a history of breast cancer. The baseline survey asked about the women's perceived risk of breast cancer, overall health, knowledge of HRT and their symptoms related to menopause. For each woman, breast cancer risk factors were used to calculate a "Gail score," a statistical scale that is used to calculate breast cancer probability. This information was used to make each woman a booklet explaining her health risks.

The women were divided randomly into two groups: one receiving individually tailored educational materials about their risk of breast cancer and information about HRT; the other receiving the materials after the study was completed. Follow-up telephone surveys were conducted at one and nine months with both groups.

"The group of women who received the tailored materials were more likely to be confident and satisfied with their decision about HRT at both one and nine months than the control group," said McBride. "These materials made women more accurate in their perceived risk of breast cancer. Many of these women were over-concerned about their risk of breast cancer, and this intervention helped them understand their true risk and weigh that against the benefits of HRT."

Lori Bastian, M.D., a co-author and associate professor of internal medicine and director of the Women's Health Program at the Durham Veteran's Administration Medical Center, said that while the women responded well to the booklet that helped them in their decision-making, many women in the study did not share the information or the process with their health care providers.

"The best-case scenario would be that women use these materials to help them make decisions and then talk them over with their doctor, so women and their doctors move forward as a team," said Bastian. "Shared decision-making by patient and physician is the goal."

Another area that concerned the researchers is that older women and African-American women seemed less likely to use the materials.

"We're not sure if this was because the older women had problems with using the materials or if African-American women did not have as much interest in hormone therapies as white women," said McBride. "It's difficult to know from this study, but it's something we hope to examine in future studies."

Twenty-four percent of the women in the study were African-American. McBride says that future studies should include community involvement to recruit more African-American women and women from a variety of socioeconomic backgrounds.

But overall, the study is a promising first step, Bastian said. "This study is just a model. As patients continue to take a more active role in their health care, and as more complex medical decisions arise from new technology -- such as genetic testing -- we are going to need decision aids that can help the both the patient and the health care provider move forward on chosen path with confidence," she said.


The study was funded by the National Cancer Institute. Additional co-authors are Susan Halabi, Ph.D.; Laura Fish; Isaac M. Lipkus, Ph.D.; Hayden B. Bosworth, Ph.D.; and Barbara K. Rimer.

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