ASSESSING THE NEED FOR AND DEVELOPING A MENOPAUSAL SYMPTOM DECISION AID IN A WOMEN'S HEALTH SPECIALTY PRACTICE

Purpose:  The Women’s Health Initiative results released in 2002 heightened fear and confusion regarding hormone therapy in the management of menopausal symptoms. Many alternative therapies exist; however the risk-benefit ratio for choosing hormonal or nonhormonal therapies for symptom relief is often confusing for patients and physicians alike.  We aimed to assess the need for and develop a decision aid (DA) for physicians counseling patients on treatment of menopausal symptoms for women within 5 years of natural menopause.

Method:  A literature search was conducted to identify the best available evidence for menopausal therapies and for validated DAs on menopausal therapy.  We conducted a focus group of all physicians in a specialized clinic in menopausal and sexual concerns to determine the need for a menopausal therapy DA.  We observed germane physician-patient encounters over a period of 6 months, with at least 2 observation sessions of each physician. Field notes recorded interactions between patients and clinicians, with focus on primary speakers, patient and physician initiated topics, and content of the visit.  Two additional focus groups consisting of physicians and allied staff treating women for menopausal symptoms provided feedback on a prototype DA.

Result:  The initial physician-focus group felt a well-designed point-of-care DA would be helpful but expressed concerns that the numerous menopause-related symptoms, co-morbidities, and wide range of treatment options were too complex for a DA. Shadowing results indicated that physicians are the primary discussants during clinical encounters and were centered on hormone therapy risks.  Comprehending the vast amount of information presented appeared difficult for patients. Based on the physician focus group, provider-patient observations, literature search, and input from experts in DA development and design, the authors developed an issues-driven point-of-care DA. The initial prototypes were well-received by the healthcare provider focus groups and feedback was used to inform subsequent versions. 

Conclusion: Physicians’ support of developing a DA for menopausal symptoms was enhanced following involvement in the decision to develop and provide input on several prototypes.  Although patient input is a necessary step in DA development, initial buy-in by physicians as end-stage users is critical, as DA use is determined by clinicians.  After this initial process, we are now ready to test the DA in real patient encounters.