RATIONALE: Given increasing knowledge of the benefits and risks of preventive hormone therapy (PHT) for women after menopause, there is a clear need for understanding of women's preferences and their physician's judgments and practices in its use. Existing knowledge of physician practice patterns is based on self-reported physician practice in narrowly defined physician populations which limits the generalizability of findings.
SPECIFIC AIMS :
The specific aims are (1) to describe and compare the clinical decision policies, self-reported practice, and patient-reported physician practice of physicians regarding the use of preventive hormone therapy for post-menopausal women age 50-59 and (2) to identify physician, office, and patient factors associated with differences in clinical decision policies and practices between and within groups of physicians. SUBJECTS: 900 physicians, 300 from each of three specialties-family physicians/general practitioners, internists, and gynecologists currently practicing in Washington, Alaska, Montana, and Idaho will be randomly sampled across four strata defined by the four states and weighted by the proportion of physicians from the target population in each state. MEASUREMENTS: Three surveys will be completed in three related samples from the three specialty groups. Physician self-reported practice and attitudes will be collected by a survey mailed to the 300 physicians in each specialty. Clinical decision policies will be measured by mailed case vignettes in a subsample of 143 physicians in each specialty randomly sampled across state strata. Physician practice will be measured by 40 mailed patient surveys per physician practice in a random subsample of 28 physicians in each specialty who return the clinical decision policies survey. SIGNIFICANCE AND LONG-TERM OBJECTIVES: The outcome will be an understanding of physician policies and practices which can inform interventions. The broad objectives are to integrate this knowledge with an understanding of patient preferences to create a model of physician and patient shared decision making similar to that which has been developed for the management of benign prostatic hypertrophy in males.
| Saver, Barry G; Gustafson, David; Taylor, Thomas R et al. (2007) A tale of two studies: the importance of setting, subjects and context in two randomized, controlled trials of a web-based decision support for perimenopausal and postmenopausal health decisions. Patient Educ Couns 66:211-22 |
| Saver, B G; Taylor, T R; Woods, N F (1999) Use of hormone replacement therapy in Washington State: is prevention being put into practice? J Fam Pract 48:364-71 |
| Woods, N F; Saver, B; Taylor, T (1998) Attitudes toward menopause and hormone therapy among women with access to health care. Menopause 5:178-88 |
| Saver, B G; Taylor, T R; Woods, N F et al. (1997) Physician policies on the use of preventive hormone therapy. Am J Prev Med 13:358-65 |
