HRT Decision Support for Women with Mobility Impairment

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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.