Communicating the Benefits/Harms of Estrogen-Progestin Hormone Therapy With Decision Aids

Annette O'Connor, RN, PhD, Valerie Tait, PhD, Dawn Stacey, RN, MScN, France Légaré, MD, MSc

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In This Article

Introduction

With the early cessation of the Women's Health Initiative (WHI) trial of continuous, oral combined estrogen-progestin therapy,[1] millions of menopausal and postmenopausal women are facing a decision. Women already taking hormone therapy (HT), and more specifically those taking the combination of HT used in the WHI, need to consider: "Should I continue or stop?" Another group, comprising women who are experiencing hot flashes and associated sleep and mood disturbances unrelieved by conservative methods, are asking: "Should I start?" This scale of decision making stimulated by a trial is unprecedented in women's health. Menopausal women have consistently expressed their desire for clear information on risks and benefits of HT and active involvement in the decision.[2,3,4] The need for clear communication and interventions to support decision making about HT has never been greater.

For such decisions, clinical guideline groups[5,6,7,8] advocate a "shared decision making" style of counseling. This entails: (1) practitioners communicating personalized information about options, outcomes, probabilities, and uncertainties; (2) women communicating the personal value or importance they place on benefits vs harms; and (3) women and their practitioners reaching agreement on the best strategy. To streamline the process, evidence-based patient decision aids have been developed as adjuncts to counseling.[9] This article provides a brief overview of patient decision aids by defining them, identifying situations for which they may be needed, describing their efficacy, and discussing practical issues surrounding their use in clinical practice. Available decision aids relevant to the HT decision are presented.

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