Ghali W A, Freund K M, Boss R D, Ryan C A, Moskowitz M A
Health Care Research Unit, Evans Department of Medicine, Boston Medical Center, Massachusetts, USA.
Am J Med. 1997 Jul;103(1):3-10. doi: 10.1016/s0002-9343(97)90049-8.
Physicians need to be aware of their patients' attitudes toward menopause when counseling women regarding hormone therapy, because menopausal attitudes may affect women's satisfaction with their decisions to use or not to use hormone therapy. Our objectives were to assess physician awareness of patient attitudes on issues surrounding the menopause and hormone therapy, and to determine the prevalence and correlates of hormone use.
This cross-sectional survey study was conducted in the primary care outpatient practices of an academic medical center. Surveys were simultaneously administered to female patients aged 50 to 70 years (n = 182) and their primary care physicians immediately after clinical encounters. The surveys contained questions from four established (five-point) attitudinal scales (autonomy, desire for information, philosophy of the menopause, barriers to use of hormone therapy), and questions addressing patients' degree of concern about developing various conditions. Physicians were asked to estimate their patients' attitudes.
Physicians were generally aware of patients' desire for autonomy (3.2 versus 3.2, P = 1.0), but tended to underestimate patients' desire for information (3.7 versus 4.5, P = 0.0001) and patients' perceptions of barriers to using hormone therapy (3.2 versus 3.4, P = 0.0001). They also underestimated the extent to which patients view menopause as a medical problem (3.0 versus 3.2, P = 0.0001). Physicians overestimated patients' general concern about heart disease (scale difference 0.40, P = 0.0001) and breast cancer (difference 0.23, P = 0.02). Physicians were less aware of their patients' attitudes when they were male (versus female), interns/residents (versus faculty/fellows), and less knowledgeable about menopausal hormone therapy (versus more knowledgeable). The significant predictors of hormone use on multivariate analysis were past hysterectomy, urinary incontinence, alcohol intake, and possession of knowledge regarding hormone therapy.
Physicians incorrectly estimate some aspects of their patients' attitudes regarding menopause and hormone therapy, and certain physician characteristics may be associated with decreased awareness. To optimize hormone therapy counseling, physicians may need to increase their attention to patients' menopausal attitudes.
在就激素疗法向女性提供咨询时，医生需要了解患者对更年期的态度，因为更年期态度可能会影响女性对使用或不使用激素疗法决定的满意度。我们的目标是评估医生对患者在更年期及激素疗法相关问题上态度的认知，并确定激素使用的患病率及相关因素。
这项横断面调查研究在一所学术医疗中心的初级保健门诊进行。在临床诊疗结束后，立即同时对50至70岁的女性患者（n = 182）及其初级保健医生进行调查。调查包含来自四个既定的（五分制）态度量表（自主性、信息需求、更年期观念、激素疗法使用障碍）的问题，以及关于患者对患各种疾病担忧程度的问题。要求医生估计其患者的态度。
医生总体上了解患者对自主性的需求（3.2对3.2，P = 1.0），但往往低估患者对信息的需求（3.7对4.5，P = 0.0001）以及患者对使用激素疗法障碍的认知（3.2对3.4，P = 0.0001）。他们还低估了患者将更年期视为医学问题的程度（3.0对3.2，P = 0.0001）。医生高估了患者对心脏病（量表差异0.40，P = 0.0001）和乳腺癌（差异0.23，P = 0.02）的总体担忧。当医生为男性（相对于女性）、实习生/住院医师（相对于教职员工/研究员）且对更年期激素疗法了解较少（相对于了解较多）时，对患者态度的认知较少。多变量分析中激素使用的显著预测因素为既往子宫切除术、尿失禁、酒精摄入量以及对激素疗法的了解程度。
医生错误估计了患者在更年期及激素疗法方面态度的某些方面，某些医生特征可能与认知度降低有关。为优化激素疗法咨询，医生可能需要更加关注患者的更年期态度。
