Patient-Identified Needs for Hormone Replacement Therapy Counseling: A Qualitative Study

Patient-Identified Needs for Hormone Replacement Therapy Counseling: A Qualitative Study

Maureen T. Connelly, MD, MPH;
Nancy Ferrari, AB;
Nicole Hagen, BA, MHS; and
Thomas S. Inui, ScM, MD

From Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts.

Abstract

Background: Numerous medical organizations, including the American College of Physicians, have recommended that women be counseled about postmenopausal hormone replacement therapy (HRT). Patients' perspectives on their counseling needs, however, have not been integrated into most counseling guides.

Objective: To use patient self-reports to identify needs for HRT counseling.

Design: Individual, in-depth patient interviews.

Setting: Managed care organization.

Patients: 26 women who had received an initial prescription for HRT.

Measurements: Qualitative, consensus review of the content of interview transcripts.

Results: On average, women reported 15 factors (range, 6 to 24 factors) as critical to their decision-making process. Although most women cited their physician's opinion (96%), reports in the media (81%), and experiences and opinions of friends (77%) as critical to their decisions about HRT, counseling recommendations address none of these concerns.

Conclusions: Many women in a managed care organization who accepted a prescription for HRT identified counseling needs that are not included in widely used HRT guidelines.

Article and Author Information

Grant Support: In part by the Robert H. Ebert, M.D., Fellowship of the Harvard Pilgrim Health Care Foundation; National Research Service Awards 2T32PE11001-06, 5T32PE11001-07, and 1F32HS00107-01; and an unrestricted grant from Consumer Value Stores, Inc.
Requests for Reprints: Maureen T. Connelly, MD, MPH, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 126 Brookline Avenue, Suite 203, Boston, MA 02215.
Current Author Addresses: Dr. Connelly: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 126 Brookline Avenue, Suite 203, Boston, MA 02215.
Ms. Ferrari: Health Publications Group at Harvard Medical School, 164 Longwood Avenue, Boston, MA 02115.
Ms. Hagen: Brown and Toland Physician Services Organization, 1388 Sutter Street, Suite 400, San Francisco, CA 94109.
Dr. Inui: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 126 Brookline Avenue, Suite 200, Boston, MA 02215.