HRT Decision Making in the Post-WHI Era

描述（由申请人提供）：妇女健康倡议改变了我们对激素替代疗法（HRT）的风险和益处的理解。女性和医疗服务提供者将对这些发现作何反应尚不得而知。令人惊讶的是，人们对如何帮助女性成功停止激素替代疗法知之甚少。我们的主要目标是：1)使用定性方法（访谈，焦点小组）来确定围绕妇女健康倡议后妇女和提供者关于HRT共同决策的新的突出领域，重点是HRT停止；2)利用访谈和焦点小组的调查结果，对妇女和提供者进行调查，描述她们在WHI后成功或试图停止HRT的经历，并确定谁试图戒烟，谁成功了，以及哪些方法最有可能导致HRT成功停止；3)使用调查来；a)描述whi后与HRT决策相关的知识、态度、信念和做法；(b)与《世界卫生调查》发表前的调查结果进行比较；C)描述响应的区域差异；4)描述1995-2005年HRT开始和终止率的时间趋势，以评估WHI和其他HRT试验结果发布的影响。该研究将在团体健康合作社和哈佛朝圣者健康保健中心进行。为了实现这些目标，我们将：1)对45至60岁的妇女和卫生保健提供者进行关于HRT的深入电话访谈；2)在45至60岁的妇女和保健提供者中开展焦点小组；3)分析访谈和焦点小组数据，设计调查，捕捉围绕HRT决策，继续和停止的突出问题；4)对45-70岁的女性进行电话调查，描述HRT停药成功和不成功的经历，了解HRT知识、态度、信念和行为；5)对卫生保健提供者进行调查，以确定关于激素替代疗法的知识、态度、信念和处方做法，以及用于帮助妇女停止激素替代疗法的策略；6)通过将新的调查数据与1995年至1999年进行的调查进行比较，审查妇女和提供者对激素替代疗法的态度和信念的时间趋势；7)使用自动化药房数据描述1995-2005年11年间HRT使用的流行率和发生率。在HRT的风险和益处越来越清晰的时代，这项研究将提供关于HRT决策的关键信息，以及HRT停药的经验。

DESCRIPTION (provided by applicant): The Women's Health Initiative has changed our understanding of the risks and benefits of hormone replacement therapy (HRT). How women and providers will react to these findings is unknown. Surprisingly little is known about how to help women successfully discontinue HRT. Our primary aims are to: 1) Use qualitative methods (interviews, focus groups) to identify new salient domains surrounding shared decision making about HRT for women and providers post WHI, with an emphasis on HRT discontinuation; 2) Using the findings from interviews and focus groups, develop and conduct surveys of women and providers to describe their experiences with successful or attempted HRT discontinuation post WHI, and determine who tries to quit, who succeeds, and what approaches are most likely to lead to successful HRT discontinuation; 3) Use surveys to; a) describe knowledge, attitudes, beliefs, and practices related to HRT decision making post-WHI; b) compare responses to those from surveys conducted before the release of the WHI; c) describe regional variations in responses; and 4) Describe temporal trends in rates of HRT initiation and discontinuation, 1995-2005, to evaluate the impact of the release of findings from the WHI and other HRT trials. The study will be conducted at Group Health Cooperative and Harvard Pilgrim Health Care. To accomplished these aims we will: 1) Conduct in depth telephone interviews about HRT, among women aged 45 to 60 years, and health care providers; 2) Conduct focus groups among women aged 45 to 60 years, and health care providers; 3) Analyze interview and focus group data to design surveys that capture the salient issues around HRT decision making, continuation and discontinuation; 4) Conduct telephone surveys of women, aged 45-70 years, to describe experiences with successful and unsuccessful HRT discontinuation, and ascertain HRT knowledge, attitudes, beliefs, and behaviors; 5) Conduct surveys of health care providers, to ascertain knowledge, attitudes, beliefs, and prescribing practices regarding HRT, and strategies used to help women discontinue HRT; 6) Examine temporal trends in women's and providers attitudes and beliefs about HRT, by comparing new survey data to surveys conducted between 1995 and 1999; 7) Use automated pharmacy data to describe the prevalence and incidence rates of HRT use over the 11-year period from 1995-2005. This study will provide key information about HRT decision making, and experiences with HRT discontinuation, in an era of increased scientific clarity about HRT's risks and benefits.