HRT Decision Support for Women with Mobility Impairment

描述(由申请者提供)：Healthy People 2010，美国护士协会和美国医师学会都建议中年女性接受关于激素替代疗法(HRT)的风险和好处的咨询。关于长期结果的相互矛盾的科学证据使HRT的使用引起了争议。然而，更年期女性不能等到科学证据变得更具决定性时才做出这一决定。在这样一个不确定的决策环境中，护理干预是最需要的，以解决与这一决策相关的风险和收益的不确定性和/或价值敏感性(O‘Connor，1988)。行动不便的妇女在使用激素替代疗法方面面临特殊挑战。由于她们进入更年期时负重和有氧运动史减少，她们患骨质疏松症和心血管疾病的风险可能更大。作为残疾的一部分而经历体温波动的女性可能会发现更年期可能发生的血管运动不稳定特别麻烦。虽然激素替代疗法可能对这些女性特别有益，但她们也可能面临更高的血栓形成风险。因此，有关使用激素替代疗法的风险和益处的现有信息必须针对这一人群的特殊需求进行调整。先前的研究表明，在使用基于理论的决策支持干预后，非残疾女性增加了她们的HRT知识，个人价值观和选择之间的一致性，对决策的满意度，并减少了她们的决策冲突(O‘Connor等人，1998)。这项研究的目的是测试这种干预的改编版本，旨在帮助行动不便的女性在知情的情况下选择使用HRT。200名行动不便的中年妇女将被随机分配到根据她们的特殊需要进行调整的决策支持干预，或标准的教育小册子。多元方差分析将被用来评估从干预前到干预后立即以及干预后6个月决策结果的变化。这项研究的结果将有助于护士和其他提供者在更年期期间就关键的卫生保健决定向行动不便的妇女提供咨询。

DESCRIPTION (provided by applicant): Healthy People 2010, the American Nurses Association, and the American College of Physicians have all recommended that mid-life women be counseled about the risks and benefits of hormone replacement therapy (HRT). Conflicting scientific evidence about long-term outcomes has made HRT use controversial. Menopausal women, however, cannot wait until the scientific evidence becomes more decisive to make this decision. In such an uncertain decision environment, nursing interventions are most needed to address the unsure and/or value sensitive nature of the risks and benefits associated with this decision (O'Connor, 1988). Women with mobility impairments face special challenges regarding HRT use. Because they enter menopause with decreased weight bearing and aerobic activity histories, they may be at greater risk for Osteoporosis and cardiovascular disease. Women who experience temperature fluctuations as part of their disability may find the Vasomotor instability that can occur during menopause particularly troublesome. While HRT might be particularly beneficial to these women, they may also be at increased risk of thrombosis. Consequently, existing information about the risks and benefits associated with HRT use must be tailored to the special needs of this population. Previous research has indicated that, following use of a theoretically based decision support intervention, non-disabled women increased their HRT knowledge, congruence between personal values and choices, satisfaction with the decision, and decreased their decisional conflict (O'Connor, et al., 1998). The aim of this study is to test an adapted version of this intervention, designed to assist women with mobility impairments in making informed choices about HRT use. Two hundred mid-life women with mobility impairments will be randomly assigned either to a decision support intervention, which has been adapted to their special needs, or to a standard educational pamphlet. Multiple Analysis of Variance will be used to assess changes in decision outcomes from pre-intervention to immediate post-intervention and 6 months following the intervention. Findings from this study will assist nurses and other providers to counsel women with mobility impairments about key health care decisions during menopause.