A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation

被引:473
作者
O'Connor, AM [1 ]
Tugwell, P
Wells, GA
Elmslie, T
Jolly, E
Hollingworth, G
McPherson, R
Bunn, H
Graham, I
Drake, E
机构
[1] Univ Ottawa, Sch Nursing, Ottawa, ON K1N 6N5, Canada
[2] Univ Ottawa, Fac Med, Ottawa, ON K1N 6N5, Canada
[3] Ottawa Civic Hosp, Loeb Res Inst, Clin Epidemiol Unit, Ottawa, ON K1Y 4E9, Canada
基金
英国医学研究理事会;
关键词
decision making; women's health; choice behavior; informed consent; decision support techniques; patient education; patient participation; health education; consumer satisfaction; hormone replacement therapy (HRT); menopause;
D O I
10.1016/S0738-3991(98)00026-3
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Although postmenopausal women are advised to consider their values when deliberating about potential benefits and risks of hormone therapy (HRT), feasible, effective methods of decision support in primary care have yet to be established. Using an explicit decision support framework, we developed a self-administered HRT decision aid and evaluated it in a before/after study of 94 women from six family practices. An audiotape guided women through an illustrated booklet including: detailed information about HRT benefits and risks tailored to a woman's clinical risk, and a values clarification exercise to promote informed decision making consistent with personal values. After using the decision aid participants: had better general knowledge and more realistic personal expectations of HRT benefits and risks; and, felt more certain, informed, clear about values, and supported in decision making. Women's values elicited in the clarification exercise were 84% accurate in discriminating between decisions. Women with polarized preferences at baseline did nor change their minds, but were better informed. Changes in preferences occurred in the uncertain group, with equal numbers accepting or declining HRT. Most participants found the decision aid comprehensible, acceptable in length and pace, and balanced. Decision aids are useful in preparing women for decision making about this complex, personal issue. (C) 1998 Elsevier Science Ireland Ltd.
引用
收藏
页码:267 / 279
页数:13
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