HRT Decision Making in the Post-WHI Era

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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.