Menopausal Hormone Therapy: Physician Awareness of Patient Attitudes

BACKGROUND: Physicians need to be aware of their patientsʹ attitudes toward menopause when counseling women regarding hormone therapy, because menopausal attitudes may affect womenʹs satisfaction with their decisions to use or not to use hormone therapy. Our objectives were to assess physician awareness of patient attitudes on issues surrounding the menopause and hormone therapy, and to determine the prevalence and correlates of hormone use. METHODS: This cross-sectional survey study was conducted in the primary care outpatient practices of an academic medical center. Surveys were simultaneously administered to female patients aged 50 to 70 years (n = 182) and their primary care physicians immediately after clinical encounters. The surveys contained questions from four established (five-point) attitudinal scales (autonomy, desire for information, philosophy of the menopause, barriers to use of hormone therapy), and questions addressing patientsʹ degree of concern about developing various conditions. Physicians were asked to estimate their patientsʹ attitudes. PATIENTS AND METHODS: Physicians were generally aware of patientsʹ desire for autonomy (3.2 versus 3.2, P = 1.0), but tended to underestimate patientsʹ desire for information (3.7 versus 4.5, P = 0.0001) and patientsʹ perceptions of barriers to using hormone therapy (3.2 versus 3.4, P = 0.0001). They also underestimated the extent to which patients view menopause as a medical problem (3.0 versus 3.2, P = 0.0001). Physicians overestimated patientsʹ general concern about heart disease (scale difference 0.40, P = 0.0001) and breast cancer (difference 0.23, P = 0.02). Physicians were less aware of their patientsʹ attitudes when they were male (versus female), interns/residents (versus faculty/fellows), and less knowledgeable about menopausal hormone therapy (versus more knowledgeable). The significant predictors of hormone use on multivariate analysis were past hysterectomy, urinary incontinence, alcohol intake, and possession of knowledge regarding hormone therapy. CONCLUSIONS: Physicians incorrectly estimate some aspects of their patientsʹ attitudes regarding menopause and hormone therapy, and certain physician characteristics may be associated with decreased awareness. To optimize hormone therapy counseling, physicians may need to increase their attention to patientsʹ menopausal attitudes.