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Richardson MK, Coslov N, Woods NF. Seeking Health Care for Perimenopausal Symptoms: Observations from The Women Living Better Survey. J Womens Health (Larchmt) 2023; 32:434-444. [PMID: 36656145 PMCID: PMC10079240 DOI: 10.1089/jwh.2022.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: The perimenopausal health care interaction can be challenging both for those seeking care and health care professionals (HCPs). We explore the factors that contribute to making these health care interactions either satisfying or unsatisfying for a midlife person with ovaries who consults an HCP about bothersome symptoms. Materials and Methods: Respondents to the Women Living Better (WLB) survey were asked about 61 symptoms often associated with the menopausal transition. They were then asked whether they sought health care for their most bothersome one. Of the 1024 participants who consulted an HCP, 964 provided a response to the open-ended question "how did that go?" We used conventional content analysis to code the responses and identify themes. Results: We identified six codes reflecting positive health care interactions which we then grouped into five themes suggesting satisfaction with these health care interactions. These included: validating experiences; having matching explanatory models; being supported by a team; engaging in shared decision-making; and having symptoms addressed. We identified 13 codes reflecting negative health care interactions which we then group into 4 themes suggesting dissatisfaction. These included: invalidating experiences, a mismatch in expectations between care recipients and HCP, barriers to treatment, and not feeling helped. Conclusions: Those seeking health care for bothersome symptoms on the path to menopause responded with both positive and negative comments about health care interactions in the WLB survey. Studying these comments identifies opportunities to improve midlife care.
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Affiliation(s)
- Marcie K Richardson
- Department of Obstetrics and Gynecology, Atrius Health and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nina Coslov
- Women Living Better, Cambridge, Massachusetts, USA
| | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
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Dayaratna S, Sifri R, Jackson R, Powell R, Sherif K, DiCarlo M, Hegarty SE, Petrich A, Lambert E, Quinn A, Myers R. Preparing women experiencing symptoms of menopause for shared decision making about treatment. Menopause 2021; 28:1060-1066. [PMID: 34260477 DOI: 10.1097/gme.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a decision support intervention that can be used with women experiencing menopausal symptoms to facilitate treatment shared decision making. METHODS Our research team contacted patients with reported menopausal symptoms by telephone to obtain consent and administer a baseline survey. Subsequently, we sent participants a booklet on the treatment of menopausal symptoms. A nurse educator then contacted participants by telephone to review the booklet and guide them through a structured decision counseling exercise designed to help clarify treatment preference. A 60-day endpoint telephone survey was completed. RESULTS Forty-eight consenting participants completed the baseline survey and 37 (77%) also completed a decision counseling session. At baseline, 19 of the women who had decision counseling were not being treated for menopausal symptoms and 18 were being treated. After decision counseling, 13 (68%) participants who were not being treated and 14 (78%) who were being treated identified a preferred treatment. Comparison of baseline and endpoint survey data showed that participant treatment knowledge increased (P = 0.007) and treatment decisional conflict decreased (P < 0.001). Furthermore, 71% of participants reported that they had received new information about treatment and 94% said they believed better prepared to discuss treatment with their healthcare provider. CONCLUSIONS Nurse-led decision counseling increased participant treatment knowledge, reduced treatment decisional conflict, and helped to clarify treatment preference. Implementation of this strategy could help to facilitate provider-patient shared decision making about the treatment of menopausal symptoms.
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Affiliation(s)
- Sandra Dayaratna
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Randa Sifri
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca Jackson
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Rhea Powell
- Division of Internal Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Katherine Sherif
- Division of Women's Health, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Sarah E Hegarty
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Anett Petrich
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Emily Lambert
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Anna Quinn
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Ronald Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
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Kuo AMS, Thavalathil B, Elwyn G, Nemeth Z, Dang S. The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead. Med Decis Making 2018; 38:1040-1045. [PMID: 30226100 DOI: 10.1177/0272989x18796223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. METHODS A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. RESULTS Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. DISCUSSION Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.
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Affiliation(s)
- Alyce Mei-Shiuan Kuo
- University of Miami, Coral Gables, FL (AMK).,Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL (BT, SD).,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (GE).,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL (ZN, SD)
| | - Berry Thavalathil
- University of Miami, Coral Gables, FL (AMK).,Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL (BT, SD).,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (GE).,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL (ZN, SD)
| | - Glyn Elwyn
- University of Miami, Coral Gables, FL (AMK).,Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL (BT, SD).,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (GE).,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL (ZN, SD)
| | - Zsuzsanna Nemeth
- University of Miami, Coral Gables, FL (AMK).,Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL (BT, SD).,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (GE).,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL (ZN, SD)
| | - Stuti Dang
- University of Miami, Coral Gables, FL (AMK).,Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL (BT, SD).,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (GE).,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL (ZN, SD)
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Blümel JE, Arteaga E, Parra J, Monsalve C, Reyes V, Vallejo MS, Chea R. Decision-making for the treatment of climacteric symptoms using the Menopause Rating Scale. Maturitas 2018; 111:15-19. [PMID: 29673828 DOI: 10.1016/j.maturitas.2018.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The Menopause Rating Scale (MRS) is one of the most frequently used instruments to evaluate menopausal symptoms; however, no cut-off score is given that would indicate the need for treatment. Our goal was to determine such a cut-off score on the MRS, using as a standard a woman's own perception of her need for treatment in relation to the severity of her symptoms. MATERIAL AND METHODS The sample comprised 427 healthy women aged 40-59 years who were not taking hormonal treatment. Based on the concept of quality of life, we considered that the patient required treatment if she herself believed that she required it, on the basis of the severity of at least one of her menopausal symptoms. To obtain an optimal MRS cut-off score associated with the need for treatment, an ROC curve analysis was performed. RESULTS The symptoms rated "very severe" on the MRS (i.e. that most require treatment) were physical and mental exhaustion (95.8% of women) and muscle and joint discomfort (95.1%). In total, 378 women (88.5%) considered that their symptoms required treatment. The ROC curve analysis determined that the optimal cut-off score on the MRS to indicate the need for treatment would be 14 (area under the curve 0.86, p < 0.0001). This score achieved 76.5% sensitivity and 83.6% specificity. With this cut-off score, 97.1% of the women who considered that they required treatment for at least one of their symptoms would be treated. There was concordance of more than 90% between this cut-off score and a score of 4 (i.e. a rating of "very severe") for any of the symptoms on the scale. CONCLUSIONS An MRS score ≥14 indicates the need for treatment for climacteric symptoms. In clinical practice, a score of 4 for any of the MRS items could be taken to indicate the need for treatment.
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Affiliation(s)
- Juan Enrique Blümel
- Department of Internal Medicine (South), Faculty of Medicine, Universidad de Chile, Santiago, Chile.
| | - Eugenio Arteaga
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Parra
- Department of Internal Medicine (South), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Carolina Monsalve
- Department of Internal Medicine (South), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Valentina Reyes
- Department of Internal Medicine (South), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Rosa Chea
- Department of Internal Medicine (South), Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Bae JM. The clinical decision analysis using decision tree. Epidemiol Health 2014; 36:e2014025. [PMID: 25358466 PMCID: PMC4251295 DOI: 10.4178/epih/e2014025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients' value.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Genuis SK. Social Positioning Theory as a lens for exploring health information seeking and decision making. QUALITATIVE HEALTH RESEARCH 2013; 23:555-567. [PMID: 23427080 DOI: 10.1177/1049732312470029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article I use Social Positioning Theory to explore the experiences of women as they interact with and make sense of evolving health information mediated by formal and informal sources. I investigate how women position themselves within their accounts of information seeking, and the influence of positioning on interactions with health professionals (HPs). Interviewed women gathered and valued information from a range of sources, and were likely to position themselves as autonomous, rather than collaborative or dependent. Faced with evolving health information, women felt responsible not only for information seeking, but also for making sense of gathered and encountered information. Participants did, however, value information provided by HPs and were likely to view decision making as collaborative when HPs fostered information exchange, appeared to appreciate different types of knowledge and cognitive authority, and supported women in their quests for information. Implications for shared decision making are discussed.
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Genuis SK. Constructing “sense” from evolving health information: A qualitative investigation of information seeking and sense making across sources. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/asi.22691] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Crowe M, Burrell B, Whitehead L. Lifestyle risk management--a qualitative analysis of women's descriptions of taking hormone therapy following surgically induced menopause. J Adv Nurs 2011; 68:1814-23. [PMID: 22082259 DOI: 10.1111/j.1365-2648.2011.05873.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This article is a report of a study that examined how women describe their decisions in relation to the use of menopausal hormone therapy following surgical menopause. BACKGROUND Women who have had a surgically induced menopause generally experience more intense menopausal symptoms than natural menopause and are regularly prescribed menopausal hormone therapy. Since 2002 the risks associated with this therapy have been widely reported. METHOD This study is a qualitative analysis of semi-structured interviews between March and May 2009 with 30 participants who had experienced surgical menopause and were, or had in the past, taken menopausal hormone therapy. This was a community sample recruited in Christchurch, New Zealand. A risk management theoretical approach underpinned the analysis. FINDINGS The womens' descriptions of managing the risks associated with menopausal therapy fell into two main themes: Life has to go on and Waiting for someone to tell me. All these women had either made an active decision to continue on treatment because of the impact of menopausal symptoms or took their doctor's advice to continue. A less dominant theme but one that was also evident was Relying on my body to get me through in which the women had decided to discontinue treatment because they regarded it as unnatural. CONCLUSION The study provided insights into how women utilize an experiential reasoning process to manage the health and lifestyle risks associated with taking menopausal hormone therapy. Nurses need to be aware of how this process influences women's reasoning processes when working with women following surgical menopause.
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Affiliation(s)
- Marie Crowe
- Centre for Postgraduate Nursing, University of Otago, Christchurch, New Zealand.
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Menard P, Stacey D, Légare F, Woodend K. Evaluation of a natural health product decision aid: A tool for middle aged women considering menopausal symptom relief. Maturitas 2010; 65:366-71. [DOI: 10.1016/j.maturitas.2009.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/06/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
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