Singh Betsy, Liu Xiao-Dong, Der-Martirosian Claudia, Hardy Mary, Singh Vijay, Shepard Neil, Gandhi Sonal, Khorsan Raheleh
Southern California University of Health Sciences, Whittier, Calif, USA.
Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):693-700. doi: 10.1016/j.ajog.2005.02.080.
This survey intended to clarify physicians' understanding of the issues surrounding women, menopause, alternative medicine, and drug therapy for the treatment of menopause.
This study was designed as a national probability sample survey of primary care physicians and gynecologists nationwide. Its focus was to identify major concerns and issues identified by patients about menopause and perceived communication with effectiveness how to communicate with their patients. Physicians were also asked to rate their comfort level in recommending the use of herbal remedies and which herbal remedy they felt comfortable recommending to interested patients.
Data indicated that a patient's complaint about menopausal symptoms was the most common factor leading to discussion of menopausal issues with physicians (91%) and that the primary concern to the patient was management of menopausal symptoms. Other factors were controversies about hormone replacement therapy, long-term health implications of menopause, and hormone replacement therapy. Eighty percent of the physician found confusing messages with regard to menopause to be the most challenging aspect in patient communication. The second most challenging issue is "inconclusive data about hormone replacement therapy" (56%). Seventy-six percent of the physicians found "showing sympathy" to be the most important factor for the physicians to communicate effectively with patients, whereas "being honest and open" was the most important patient attitude cited for the same purpose. When it comes to herbal therapy for menopause symptom control, only 4% of the physicians indicated that none of their patients take any remedies. Only 18% were not very comfortable in discussing or recommending herbal therapies, whereas the rest ranged from fairly comfortable to completely comfortable.
This study has provided data with regard to physician understanding of menopause treatment options and their primary interaction with patients on this issue. More in-depth studies concerning efficacy and/or side effects of each available treatment will be the relevant next step, given the controversies about both hormone replacement therapy and alternative therapies. The relative efficacy, safety, and cost-effectiveness of different treatments should also be put into the context of both clinical diagnosis and physicians' clinical judgment. Attention to comments by physicians and patients with regard to communication may produce better information exchange and trust between patient and physician.
本次调查旨在阐明医生对围绕女性、更年期、替代医学以及更年期药物治疗等问题的理解。
本研究设计为对全国基层医疗医生和妇科医生进行的全国概率抽样调查。其重点是确定患者提出的关于更年期的主要担忧和问题，以及他们认为与患者沟通有效性的方式。医生们还被要求对推荐使用草药疗法的舒适度进行评分，以及他们觉得向感兴趣的患者推荐哪种草药疗法比较合适。
数据表明，患者对更年期症状的抱怨是导致与医生讨论更年期问题的最常见因素（91%），并且患者最主要的担忧是更年期症状的管理。其他因素包括激素替代疗法的争议、更年期对长期健康的影响以及激素替代疗法。80%的医生发现关于更年期的信息混乱是患者沟通中最具挑战性的方面。第二大具有挑战性的问题是“激素替代疗法的数据不确定”（56%）。76%的医生认为“表达同情”是医生与患者有效沟通的最重要因素，而“诚实和坦率”是出于同样目的被提及的最重要的患者态度。在更年期症状控制的草药疗法方面，只有4%的医生表示他们的患者都不服用任何疗法。只有18%的医生在讨论或推荐草药疗法时不太自在，而其余医生的自在程度从比较自在到完全自在不等。
本研究提供了关于医生对更年期治疗选择的理解以及他们在这个问题上与患者的主要互动的数据。鉴于激素替代疗法和替代疗法都存在争议，下一步相关的是对每种可用治疗方法的疗效和/或副作用进行更深入的研究。不同治疗方法的相对疗效、安全性和成本效益也应结合临床诊断和医生的临床判断来考虑。关注医生和患者关于沟通的意见可能会在患者和医生之间产生更好的信息交流和信任。
