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.