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Wednesday, 18 October 2006 - 10:45 AM


Nananda F. Col, MD, MPH, MPP1, Brad J. Anderson, PhD2, Griffin Weber3, Michele Cyr, MD1, Carol Landau, PhD2, and Annette M. O'Connor, PhD4. (1) Brown Medical School, Providence, RI, (2) Rhode Island Hospital, Providence, RI, (3) Harvard Medical School, Boston, MA, (4) University of Ottawa, Ottawa, ON, Canada

Purpose: Making informed decisions about hormone therapy (HT) and other menopausal treatments is increasingly difficult given the evolving and complex risk-benefit profiles of these treatments. We tested the effect of a novel web-based decision aid on the use of HT and other menopausal treatments.

Methods: WISDOM (Women's Interactive System about Decision On Menopause) provides individualized information about the impact of menopausal treatments on symptoms and risks. We recruited 232 healthy menopausal women aged 45 to 65 into a randomized controlled trial comparing WISDOM to a control group (standard care). WISDOM users were given access to the website before their clinic appointment. A summary report (generated by WISDOM) was sent to their physicians. Participants completed baseline and 2-week follow-up questionnaires. Medication use was self-report. HT included any estrogen or progestin preparations; other menopausal treatments included raloxifen, tamoxifen and bisphosphonates.

Results: A total of 213 (92%) participants completed follow-up; follow-up rates did not differ significantly by treatment group. The mean age was 53 years, 75% had completed college, and 92% were white. Overall, 23.5% received a new prescribed medication at their physician visit, with no signficant difference between WISDOM (24.3%) and controls (19.1%). However, the type of new medication prescribed differed signficantly (p=.038) between groups. WISDOM participants were less likely than controls to be pre-scribed HT (8.0% v. 28.6%) or other menopausal treatments (12.0% v 28.6%). We used logistic regression to test for possible mediation effects (increased knowledge of disease risk and decreased decisional conflict) and potential confounders (age and education). WISDOM users reported significantly larger reductions (p=.044) in decisional conflict but between group differences on change in knowledge of disease risk were not signifi-cant. The adjusted effect of the WISDOM intervention was statistically significant (p=.037); WISDOM users were estimated to be 9.7 (95%CI 1.1-86.3) times less likely than controls to receive a new prescription for either HT or other menopausal treatments. Receiving a prescription for menopausal treatment or HT was positively associated with age (p=.041) and inversely associated with education (p=.024).

Conclusions: WISDOM reduced the likelihood of being newly prescribed HT or other menopausal treatments, but change in knowledge of disease risk and change in decisional conflict did not mediate this effect.

See more of Concurrent Abstracts K: Advancing Decision Support in Medical Decision Making
See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)