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)的风险和好处的理解。女性和提供者对这些发现会有什么反应还是个未知数。令人惊讶的是，人们对如何帮助女性成功停止HRT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)确定围绕妇女和WHI后HRT提供者共同决策的新的显著领域，重点是HRT停止；2)使用访谈和焦点小组的结果，对妇女和提供者进行调查，以描述她们在WHI后成功或试图停止HRT的经验，并确定谁试图戒烟、谁成功，以及哪些方法最有可能导致HRT成功中止；3)使用调查；a)描述与WHI后HRT决策相关的知识、态度、信念和做法；B)将答复与在世界卫生倡议发布之前进行的调查的答复进行比较；c)描述答复的区域差异；以及4)描述1995-2005年期间激素替代疗法开始和停用率的时间趋势，以评估世界卫生倡议和其他激素替代疗法试验结果发布的影响。这项研究将在团体健康合作社和哈佛朝圣者健康护理中心进行。为了实现这些目标，我们将：1)在45至60岁的妇女和医疗保健提供者中深入开展关于HRT的电话访谈；2)在45至60岁的妇女和卫生保健提供者中开展焦点小组；3)分析访谈和焦点小组数据，以设计调查，以捕捉围绕HRT决策、继续和终止的突出问题；4)对45-70岁的妇女进行电话调查，描述成功和不成功的HRT停止的经验，并确定HRT的知识、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HRT的知识、态度、信念和处方做法，以及用于帮助妇女停止HRT的战略；6)通过将新的调查数据与1995至1999年间进行的调查进行比较，检查妇女和提供者对HRT的态度和信念的时间趋势；7)使用自动化药房数据来描述1995年至2005年11年期间HRT的使用率和发病率。这项研究将提供有关HRT决策的关键信息，以及在HRT风险和益处的科学清晰度不断提高的时代停止HRT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.