Women's Trust in and Use of Information Sources in the Treatment of Menopausal Symptoms

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre

BACKGROUND

While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms.

METHODS

In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods.

RESULTS

There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation.

CONCLUSIONS

Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

Relationship of patient-centered communication and cancer risk information avoidance: A social cognitive perspective

OBJECTIVE

We examined the relationship between patient-centered communication and cancer risk information avoidance and estimated the mediating role of self-efficacy in this relationship.

METHODS

Using nationally representative cross-sectional data from the U.S. Health Information National Trends Survey (N = 2033), this study aims to provide a comprehensive understanding of the relationship between patient-centered communication and cancer risk information avoidance via correlation analysis, stepwise regression models, and mediation analysis.

RESULTS

Patient-centered communication was significantly negatively associated with cancer risk information avoidance (β= -0.09, p < 0.01) after controlling for gender, income, education, and cancer risk perception. Self-efficacy fully mediated the relationship of patient-centered communication with cancer risk information avoidance.

CONCLUSION

Patient-centered communication can improve patients' self-efficacy, thereby preventing them from avoiding cancer risk information.

PRACTICE IMPLICATIONS

The negative relationship between patient-centered communication and cancer risk information avoidance substantiates that improving patient-centered communication is a promising approach to support caregivers in their activities, reduce patients' subjective cancer burden, and even improve their health. To address cancer-related issues, policymakers can consider interventions from the external environment and internal personal cognition perspectives.

SCAN! A pharmacy-based, sun safety feasibility study

OBJECTIVES

Skin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN!

METHODS

We conducted pre- and postintervention surveys of the SCAN!, a student pharmacist-led or pharmacy resident-led intervention in community pharmacies (n = 3).

RESULTS

Participants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P's < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01).

CONCLUSION

The SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.

Chronic medicine users' self-managing medication with information - A typology of patients with self-determined, security-seeking and dependent behaviors

BACKGROUND

Information on medicines is key for safety and quality of care in long-term treatment courses with medicines. Little is known on how patients self-manage medication with information, and how interactions with health professionals influence such self-managing.

OBJECTIVE

The objective of this study was to investigate how patients manage long-term medication with information, and how interactions with health professionals influence this managing, with the aim of developing a typology of patients' practices for managing with information. A secondary objective was to generate theoretical reflections on patients' roles in establishing resilience in health care systems.

METHODS

Qualitative interviews with 15 chronic medicine users. A Safety-II-approach was used to obtain knowledge of what worked for medicine users, at the same time as acknowledging hindrances. Data were analyzed using thematic analysis and Halkiers' method for ideal-typologizing.

RESULTS

Four types of practices for managing medication with information were identified, distinguished by patients' ways of self-managing on their own and through relations with health professionals: Ideal-type I: Self-determined and highly self-managing; Ideal-type II: Security-seeking and self-managing; Ideal-type III: Dependent with limited self-managing; Ideal-type IV: Co-managing with close family. The findings suggest that patients with a high degree of self-managing medication with information have good chances for facilitating quality of medical treatment. For patients who are more dependent on oral information from health professionals, the character of dialogue facilitated or hindered their self-managing. All patients had the best options for managing medication when being recognized by health professionals through dialogues.

CONCLUSION

A typology of 4 types of managing practices was developed, characterized by patients' different abilities to self-manage medication with information and their relations to health professionals. Recognizing patients' different behaviors for managing medication with information is important for maximizing treatment quality of long-term medical treatment in a modern and resilient healthcare system.

Information sources, awareness and preventive health behaviors in a population at risk of Arsenic exposure: The role of gender and social networks

The population of Paracatu is at risk of Arsenic (As) exposure associated with long-term exploration of the largest open pit gold mine in Brazil. As part of the interdisciplinary research "The Paracatu project: Arsenic environmental contamination and human health risks assessment in Paracatu-MG", carried out between 2011 and 2013, we used data disaggregated by gender to identify the sources of As-related information being accessed by inhabitants of Paracatu and to examine if access to these sources was correlated to awareness of As health effects and adoption of behaviors to reduce risk of As exposure. Semi-structured, face-to-face interviews were carried out with 460 participants (294 women and 166 men) to collect data on respondent's socio-demographic characteristics, use of mass media and social communication networks as sources of information on As issues, the trustworthiness of these information sources, awareness of As health effects, and adoption of behaviors to reduce As exposure. For both men and women, interpersonal communication was used and trusted more frequently than mass media to obtain information on As. Discussion of As issues occurred preferentially among individuals of the same gender and was associated with awareness of As health risks. There are marked differences in variables correlated with the adoption of behaviors to reduce the risk of As exposure between men and women. Discussing As issues with women was associated with adoption of risk-reduction practices for both genders. In contrast, men who discuss As issues with other men were less likely to adopt As exposure prevention behaviors. Finally, adoption was associated with awareness of As health effects for women, but this was not the case for men. Policy implications for decision makers, practitioners and researchers are discussed, based on concrete examples of how gender-specific approaches can effectively guide the formulation and implementation of health promotion campaigns and programs.

Sources of information influencing the state-of-the-science gap in hormone replacement therapy usage

Objective

Medical reviews and research comprise a key information source for news media stories on medical therapies and innovations as well as for physicians in updating their practice. The present study examined medical review journal articles, physician surveys and news media coverage of hormone replacement therapy (HT) to assess the relationship between the three information sources and whether/if they contributed to a state-of-the-science gap (a condition when the evaluation of a medical condition or therapy ascertained by the highest standards of investigation is incongruent with the science-in-practice such as physician recommendations and patient actions).

Methods

We content-analyzed 177 randomly sampled HT medical reviews between 2002 and 2014, and HT news valence in three major TV networks, newspapers and magazines/internet sites in 2002–2003, 2008–2009 and 2012–14. The focus in both analyses was whether HT benefits outweighed risks, risks outweighed benefits or both risks and benefits were presented. We also qualitatively content-analyzed all 19 surveys of US physicians’ HT recommendations from 2002 to 2009, and 2012 to 2014.

Results

Medical reviews yielded a mixed picture about HT (40.1% benefits, 26.0% risks, and 33.9% both benefits and risks). While a majority of physician surveys were pro-HT 10/19), eight showed varied attitudes and one was negative. Newspaper and television coverage reflected a pro and con balance while magazine stories were more positive in the later reporting period.

Conclusion

Medical journal review articles, physicians, and media reports all provide varying view points towards hormone therapy use thus leading to limited knowledge about the actual risks and benefits of HT among peri- and menopausal women and a state-of-the-science gap.

What midlife women want from gynecologists: a survey of patients in specialty and private practices

BACKGROUND

This study characterized the self-reported reason for a gynecology visit among midlife women in three different practice settings. We hypothesized that women seeking specialty care were more likely to report nonvasomotor symptoms potentially related to the menopausal transition.

METHODS

Participants were 625 women aged 40-60 seen by gynecologists at three sites: an urban, academic, gynecologic menopause practice (Midlife Practice, or MLP) and urban (site A) and suburban (site B) locations of a general, nonacademic obstetrics and gynecology practice. Participants completed a self-report questionnaire asking them to choose and weigh the reason for their visit as "very much," "somewhat," or "not at all" for 15 common gynecologic and menopausal concerns. Demographic questions included age, self-rated health status, race/ethnicity, difficulty of paying for basics, and education. Comparisons between the three groups were made using parametric and nonparametric tests as appropriate. The main outcome measure was the response to the reason for participants' visit compared across the three sites.

RESULTS

Women presenting to the MLP were significantly older and more likely to report vasomotor symptoms (VMS), moodiness, sexual problems, sleep problems, and weight and to learn more about menopause. When "very much" and "somewhat" reasons were combined, nearly 80% of the MLP responses listed sleep problems, 60% listed vaginal dryness or low desire, 34% listed weight gain, and 30.7% listed mood.

CONCLUSIONS

Midlife women seeking care in a menopause gynecology practice had significantly more visits for vasomotor and nonvasomotor concerns than did women seeing general gynecologists. Women sought care for a broad range of concerns that are not typically in gynecologists' scope of practice, including sleep disturbances, moodiness, and weight management.

Public trust in genomic risk assessment for type 2 diabetes mellitus

Patient trust in personal medical information is critical to increasing adherence to physician recommendations and medications. One of the anticipated benefits of learning of one's genomic risk for common diseases is the increased adoption of screening, preventive care and lifestyle changes. However, the equivocal results thus far reported of the positive impact of knowledge of genomic risk on behavior change may be due to lack of patients' trust in the results. As part of a clinical study to compare two methods of communication of genomic risk results for Type 2 diabetes mellitus (T2DM), we assessed patients' trust and preferred methods of delivery of genomic risk information. A total of 300 participants recruited from the general public in Durham, NC were randomized to receive their genomic risk for T2DM in-person from a genetic counselor or online through the testing company's web-site. Participants completed a baseline survey and three follow-up surveys after receiving results. Overall, participants reported high levels of trust in the test results. Participants who received their results in-person from the genetic counselor were significantly more likely to trust their results than those who reviewed their results on-line (p = 0.005). There was not a statistically significant difference in levels of trust among participants with increased genetic risk, as compared to other those with decreased or same as population risk (p = 0.1154). In the event they undergo genomic risk testing again, 55 % of participants overall indicated they would prefer to receive their results online compared to 28 % that would prefer to receive future results in-person. Of those participants preferring to receive results online, 77 % indicated they would prefer to have the option to speak to someone if they had questions with the online results (compared to accessing results online without the option of professional consultation). This is the first study to assess satisfaction with genomic risk testing by the method of delivery of the test result. The higher rate of trust in results delivered in-person suggests that online access reports may not result in serious consideration of results and lack of adoption of recommended preventive recommendations.

The multifaceted nature of access to compounded progesterone: a cross-sectional study from Australia

OBJECTIVE

To explore the influences on accessibility of compounded progesterone therapy for Australian women.

STUDY DESIGN

A cross-sectional survey of a stratified sample of Australian women who use progesterone only products using the 'Perspectives on Progesterone' questionnaire.

MAIN OUTCOME MEASURES

Principle components analysis (PCA) to determine components of access to progesterone treatment and multi-way analysis of variance to compare groups.

RESULTS

Women using compounded progesterone were likely to have made at least one lifestyle adaptation (73%), and to have tried and stopped using at least one complementary and alternative medicine therapy (63%) or conventional hormone therapy (41%). PCA revealed six components of access to progesterone treatment: affordable, values natural treatments and is concerned about other treatments, conventionally available, perceived knowledge, values information gathered from a variety of sources, and rural & disadvantaged. The multifaceted nature of progesterone use illustrates that there are multiple aspects to use of non-conventional medicines. Women looking for non-conventional treatment are neither stupid nor uninformed, their understandings, based on experience and research, need to be addressed by health professionals while assessing their condition prior to discussing the risks and benefits of non-conventional medicines.

CONCLUSION

Access to compounded progesterone is multifaceted, and many of the women who use it have tried other treatments first. Despite the clinical ambivalence towards progesterone as an alternative for women who may have tried and rejected other treatments, including conventional hormone therapy, the women described in this paper are using it.

Voices from the Hilo Women's Health Study: talking story about menopause

Our purpose in conducting this qualitative study was to examine how a multiethnic sample of women living in Hilo, Hawai'i, describe menopause. Interviews were conducted with 185 pre-, peri-, and post-menopausal women aged 45 to 55. We found that pre-menopausal women felt anxious compared with peri- and post-menopausal women's more affirmative attitudes of increasing confidence and freedom in this new cycle of life. A dominant theme was the construction of a post-menstrual identity. Peri-and post-menopausal women's attitudes were not biomedically oriented. Local culture and the island lifestyle may provide a positive atmosphere for women going through menopause.

Perimenstrual symptoms and symptoms at midlife in Puebla, Mexico

OBJECTIVES

To examine perimenstrual symptoms in relation to hot flushes and depressive symptoms among 755 pre- and postmenopausal women aged 40-60 years drawn from a general population in Puebla, Mexico.

METHODS

Hot flushes and depressed mood during the past 2 weeks were queried, along with cramps and other symptoms experienced during or before menstruation. Relationships among perimenstrual symptoms were examined by factor analyses. Logistic regression was used to assess determinants of hot flushes and determinants of depressed mood at midlife.

RESULTS

Fifty-four percent of the women reported abdominal cramping (cólicos) during menstruation; fewer reported irritability (8%) and depressed mood (9%). Gastrointestinal complaints were most frequently volunteered (12%), followed by breast tenderness (10%) and mid-back pain (9%). Emotional symptoms clustered separately from perimenstrual symptoms. In bivariate analyses, abdominal cramping and waist pain were associated with hot flushes at midlife (p <0.01) and remained significant determinants after controlling for potential confounders. Depressed mood with menstruation was associated with depressed mood at midlife (p <0.05). After controlling for education, socioeconomic status and parity, perimenstrual irritability and depressed mood raised the risk of midlife depressed mood, although significance was lost after adding current hot flushes and trouble sleeping.

CONCLUSIONS

The relationship between abdominal cramps and hot flushes may be hormonal or sociocultural. The lack of association between depressed mood with menstruation and depressed mood at midlife after controlling for current hot flushes and trouble sleeping suggests that concurrent difficulties were more important than past history of depression in this population.

Knowledge, perceptions and information about hormone therapy (HT) among menopausal women: a systematic review and meta-synthesis

Background

The use of hormone therapy (HT) by menopausal women has declined since the Women's Health Initiative randomized trial (WHI) in 2002 demonstrated important harms associated with long-term use. However, how this information has influenced women's knowledge and attitudes is uncertain. We aimed to evaluate the attitudes and perceptions towards HT use, as well as specific concerns and information sources on HT since the WHI trial.

Method/Results

We did a systematic review to assess the attitudes and knowledge towards HT in women, and estimate the magnitude of the issue by pooling across the studies. Using meta-synthesis methods, we reviewed qualitative studies and surveys and performed content analysis on the study reports. We pooled quantitative studies using a random-effects meta-analysis. We analyzed 11 qualitative studies (n = 566) and 27 quantitative studies (n = 39251). Positive views on HT included climacteric symptom control, prevention of osteoporosis and a perceived improvement in quality of life. Negative factors reported included concerns about potential harmful effects, particularly cancer risks. Sources of information included health providers, media, and social contact. By applying a meta-synthesis approach we demonstrate that these findings are broadly applicable across large groups of patients.

Conclusions

Although there are clear hazards associated with long-term HT use, many women view HT favorably for climacteric symptom relief. Media, as a source of information, is often valued as equivalent to health providers.

Relationships between menstrual and menopausal attitudes and associated demographic and health characteristics: the Hilo Women's Health Study

The objective of this study was to examine the relation of menstrual attitudes to menopausal attitudes and the demographic and health characteristics associated with each. This cross-sectional study consisted of a randomly selected sample of 1,824 respondents aged 16 to 100 years in multi-ethnic Hilo, Hawai'i. Women completed questionnaires for demographic and health information, such as age, ethnicity, education, residency in Hawai'i, menopausal status, exercise, and attitudes toward menstruation and menopause. Women more often chose positive terms, such as "natural," to describe menstruation (60.8%) and menopause (59.4%). In bivariate analyses, post-menopausal women were significantly more likely to have positive menstrual and menopausal attitudes than pre-menopausal women. Factor analyses were used to cluster attitudes followed by linear regression to identify demographic characteristics associated with factor scores. Asian-American ethnicity, higher education, reporting more exercise, and growing up outside of Hawai'i were associated with positive menstrual attitudes. Higher education, older age, post-menopausal status, growing up outside of Hawai'i and having hot flashes were associated with positive menopausal attitudes. Bivariate correlation analyses suggested significant associations between factor scores for menstrual and menopausal attitudes. Both negative and positive menstrual attitudes were positively correlated with the anticipation of menopause, although negative attitudes toward menstruation were negatively correlated with menopause as a positive, natural life event. Demographic variables, specifically education and where one grows up, influenced women's attitudes toward menstruation and menopause and should be considered for inclusion in subsequent multi-ethnic studies. Further research is also warranted in assessing the relationship between menstrual and menopausal attitudes.

Mulher no climatério: reflexões sobre desejo sexual, beleza e feminilidade

O climatério é um período abrangente da vida feminina, caracterizado por alterações metabólicas e hormonais que trazem mudanças envolvendo o contexto psicossocial. Tendo como referência as alterações de sexualidade vivenciadas no climatério, este trabalho tem por objetivo refletir sobre desejo sexual, beleza e feminilidade da mulher nessa fase. A metodologia adotada consistiu em estudo bibliográfico, em livros e artigos publicados, entre 1999 e 2009. A exigência exacerbada pela beleza eterna e jovialidade é agravada no climatério, no qual o corpo feminino não tem o mesmo vigor físico pelas alterações decorrentes do envelhecimento. A mulher climatérica vive o mito da perda do desejo sexual, todavia, continua a sentir prazer, não devendo deixar de manifestar amor e sexualidade. A visão social estereotipada sobre o papel da mulher (esposa e mãe) pode interferir negativamente na visão das mulheres sobre si mesmas e no seu relacionamento com as pessoas e o mundo. Nesse sentido, é importante que as mulheres tenham acesso à informação em saúde para a compreensão das mudanças do período de climatério/menopausa, contemplando e ressignificando tal fase como integrante de seus ciclos de vida e não como sinônimo de velhice, improdutividade e fim da sexualidade.

A path analysis on correlates of consumer trust in online health information: evidence from the health information national trends survey

Many people look for health information online, and the Internet is the third most trusted health information source. What implications does this trust have on consumer health? Not much research has been done in this area. This study explored various health-related correlates of consumer trust in online health information, including Internet use for health, self-efficacy belief in managing one's own health, negative emotions, and subjective health status. The 2007 Health Information National Trends Survey data were analyzed. Results showed that controlling for demographics, trust in online health information was directly related to both Internet use for health and the self-efficacy belief, and was indirectly associated with negative emotions; the latter two factors in turn were associated with self-rated health.

Recent Publications on Medications and Pharmacy

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly. Suggestions or comments may be addressed to Jacyntha Sterling, Drug Information Specialist at Saint Francis Hospital, 6161 S Yale Ave, Tulsa, OK 74136 or e-mail: jasterling@saintfrancis.com .