MENOPAUSAL HORMONE-THERAPY - PHYSICIAN AWARENESS OF PATIENT ATTITUDES

BACKGROUND: Physicians need to be aware of their patients' attitudes t oward menopause when counseling women regarding hormone therapy, becau se menopausal attitudes may affect women's satisfaction with their dec isions to use or not to use hormone therapy. Our objectives were to as sess physician awareness of patient attitudes on issues surrounding th e menopause and hormone therapy, and to determine the prevalence and c orrelates of hormone use. METHODS: This cross-sectional survey study w as conducted in the primary care outpatient practices of an academic m edical center. Surveys were simultaneously administered to female pati ents aged 50 to 70 years (n = 182) and their primary care physicians i mmediately after clinical encounters. The surveys contained questions from four established (five-point) attitudinal scales (autonomy, desir e for information, philosophy of the menopause, barriers to use of hor mone therapy), and questions addressing patients' degree of concern ab out developing various conditions. Physicians were asked to estimate t heir patients' attitudes. PATIENTS AND METHODS: Physicians were genera lly aware of patients' desire for autonomy (3.2 versus 3.2, P = 1.0), but tended to underestimate patients' desire for information (3.7 vers us 4.5, P = 0.0001) and patients' perceptions of barriers to using hor mone therapy (3.2 versus 3.4, P = 0.0001). They also underestimated th e extent to which patients view menopause as a medical problem (3.0 ve rsus 3.2, P = 0.0001). Physicians overestimated patients' general conc ern about heart disease (scale difference 0.40, P = 0.0001) and breast cancer (difference 0.23, P = 0.02). Physicians were less aware of the ir patients' attitudes when they were male (versus female), interns/re sidents (versus faculty/fellows), and less knowledgeable about menopau sal hormone therapy (versus more knowledgeable). The significant predi ctors of hormone use on multivariate analysis were past hysterectomy, urinary incontinence, alcohol intake, and possession of knowledge rega rding hormone therapy. CONCLUSIONS: Physicians incorrectly estimate so me aspects of their patients' attitudes regarding menopause and hormon e therapy, and certain physician characteristics may be associated wit h decreased awareness. To optimize hormone therapy counseling, physici ans may need to increase their attention to patients' menopausal attit udes. (C) 1997 by Excerpta Medica, Inc.