A DECISION AID FOR WOMEN CONSIDERING HORMONE-THERAPY AFTER MENOPAUSE - DECISION-SUPPORT FRAMEWORK AND EVALUATION

Although postmenopausal women are advised to consider their values whe n deliberating about potential benefits and risks of hormone therapy ( HRT), feasible, effective methods of decision support in primary care have yet to be established. Using an explicit decision support framewo rk, we developed a self-administered HRT decision aid and evaluated it in a before/after study of 94 women from six family practices. An aud iotape guided women through an illustrated booklet including: detailed information about HRT benefits and risks tailored to a woman's clinic al risk, and a values clarification exercise to promote informed decis ion making consistent with personal values. After using the decision a id participants: had better general knowledge and more realistic perso nal expectations of HRT benefits and risks; and, felt more certain, in formed, clear about values, and supported in decision making. Women's values elicited in the clarification exercise were 84% accurate in dis criminating between decisions. Women with polarized preferences at bas eline did nor change their minds, but were better informed. Changes in preferences occurred in the uncertain group, with equal numbers accep ting or declining HRT. Most participants found the decision aid compre hensible, acceptable in length and pace, and balanced. Decision aids a re useful in preparing women for decision making about this complex, p ersonal issue. (C) 1998 Elsevier Science Ireland Ltd.