Women's decisions and decisional conflict regarding long term hormone replacement therapy.

Abstract

Long term preventive hormone replacement therapy (LTP-HRT) is attracting considerable attention for its potential in reducing the incidence of coronary heart disease and osteoporosis associated fractures in post-menopausal women. The study objectives were: (1) to describe women's decisions and decisional conflict regarding LTP-HRT after being presented with the evidence of benefits and risks and clarifying values; (2) to describe the difference between those who accept or decline LTP-HRT in terms of: (a) expectations of LTP-HRT benefits and risks, and (b) the importance women attach to the benefits and the risks; and (3) to describe the factors women identify as contributing to their decision to take or not take LTP-HRT or being unsure about taking LTP-HRT. The typical woman who participated in the study was 57 years of age; had some post secondary education; and was currently using HRT. Over half the women had at least one CHD risk factor and had a hysterectomy. Less than 15% of the respondents reported having osteoporosis or a first degree relative with breast cancer. Women's decisions to take LTP-HRT were distributed as follows: 56% yes; 26% no; and 18% unsure. Women who accepted or declined LTP-HRT did not have statistically significant differences in expectations of risk of CHD, osteoporosis, and breast cancer with and without hormone therapy. In contrast, women's importance ratings of LTP-HRT benefits and side effects did differ significantly between those accepting and declining LTP-HRT. The reasons most often identified by women who chose LTP-HRT were prevention of CHD and osteoporosis (61%) and relief of hot flashes (54%). Those who chose not to take LTP-HRT gave reasons such as dislike of taking pills (47%), and risk of cancer (11%). (Abstract shortened by UMI.)