Developing and evaluating a patient decision aid for hormone therapy to manage symptoms of surgical menopause: the story behind the "SheEmpowers" patient decision aid.

OBJECTIVES: To develop and evaluate an evidence-based patient decision aid (PDA) that can support women making decisions on hormone therapy (HT) for the management of early surgical menopause. METHODS: The PDA development was guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards and involved three phases: an exploratory phase to identify women's decisional needs; a development phase to identify evidence related to treatment options and draft initial prototype; and an evaluation phase to evaluate the prototype and elicit views on acceptability in women (N = 12). All phases were driven by a multidisciplinary group of researchers, clinicians, and patient stakeholders to ensure women's priorities were met. RESULTS: A prototype PDA was drafted based on needs identified from the exploratory phase. The PDA has five domains: information on surgical menopause and HT; HT outcome probabilities; patient stories; values clarification; and guidance in deliberation. Participants in the evaluation phase perceived the tool as acceptable and offered suggestions for modifications. CONCLUSION: Through our adopted, systematic approach the SheEmpowers PDA was developed to help women overcome deterrents to decision-making related to lack of knowledge, decision-making skills, and involvement in therapy decisions. The decisional effectiveness of the tool is to be assessed in future studies.

A scoping review of interventions to promote the adoption of shared decision-making (SDM) among health care professionals in clinical practice.

OBJECTIVES: To identify and summarize evidence on interventions to promote the adoption of shared decision-making (SDM) among health care professionals (HCPs) in clinical practice. METHODS: Electronic databases including: MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane library were searched to determine eligible peer-reviewed articles. Grey literature was searched for additional interventions. Eligibility screening and data extraction were independently completed. Results are presented as written evidence summaries and tables. RESULTS: Our search yielded 238 articles that met our inclusion criteria. Interventions mostly targeted physicians (46%), had multiple educational modalities (46%), and were administered in group settings (44%) before the clinical encounter (71%). Very few were developed based on the learning needs of targeted HCPs (24%). Many of the SDM outcome tools used for evaluation were developed for the respective study and lacked evidence of validity and reliability (30%). CONCLUSION: We identified a sizable number of interventions to promote the adoption of SDM, however, these interventions were heterogeneous in their assessments for effectiveness and implementation. Therefore, it is a challenge to infer which strategies and practices are best to promote SDM adoption. PRACTICE IMPLICATIONS: The need for evidence-based standards for developing SDM interventions targeting HCPs and assessing acceptability, effectiveness and implementation is suggested.

Determinants of hormone therapy uptake and decision-making after bilateral oophorectomy (BO): A narrative review.

Objective Early surgical menopause (≤45 years) can have significant short- and long-term health consequences. Hormone therapy (HT) is recommended for women with no contraindications. However, HT is greatly underutilized among these women due to their fear of the associated risks. The objective of this study is to identify and describe determinants of HT uptake and decision-making in women after surgical menopause. Methods We searched Medline, EMBASE, and CINAHL, from inception to April 2018, to identify relevant literature. Inclusion criteria included studies that assessed factors affecting the uptake of HT and decision-making about HT after surgical menopause. Studies including both women with natural and surgical menopause were included. Search terms were derived from 3 main concepts: surgical menopause, hormone therapy, and decision-making. Papers included in the review had to be in the English language and to report human studies. Results Of the 1952 articles identified, 23 were eligible for inclusion. Studies were mostly published before the WHI (61%) and had a quantitative cross-sectional study design. Only 22% focused on surgical menopause per se. The mean age at time of surgical menopause was 43.6 years (range 29-68). HT uptake was associated with younger age, higher level of education, higher income and adopting positive lifestyle behaviors. Factors affecting decision-making were mostly perceptions, beliefs, and values women associate with HT, as well as knowledge of and experiences with HT and surgical menopause. External factors related to physicians' recommendations and information sources also influenced HT decision-making. Conclusion Our review highlights the complex nature of decision-making about HT after surgical menopause and the numerous factors involved. Women tend to rely on subjective perceptions and inferences from information sources, which may hamper the ability to make informed treatment decisions. There is a need for tailored decision-aid interventions to help support women and guide informed treatment decisions.

Perspectives and decision-making about menopausal therapies in women who had bilateral oophorectomy.

OBJECTIVE: The aim of the study was to explore the process of decision-making about menopausal treatments in women who have had surgical menopause as a result of bilateral oophorectomy (≤50 y). METHODS: We used a descriptive qualitative research design. Women who had a surgical menopause were purposefully selected from the Edmonton Menopause Clinics. Focus groups were held, each with six to nine participants. All sessions were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULTS: We conducted five focus groups from June 30 to July 21, 2016 (N = 37). One-third of the women had the surgery within the last 5 years. Almost all women had a concurrent hysterectomy (97%) and were current users of hormone therapy (70%). Four main themes identified were "perceptions of surgical menopause," "perceptions of received support," "being my own advocate," and "concept of adequate support." Women shared that the experience was worse than their expectations and did not believe they were given adequate support to prepare them to make therapy decisions. Women had to "be their own advocates" and seek support from within the healthcare system and outside to cope with their health issues. To make an informed decision about treatments postsurgery, women expressed a need to learn more about the symptoms of surgical menopause, treatment options, resources, avenues for support, and stories of similar experiences, preferably before the surgery. CONCLUSIONS: We identified several modifiable deterrents to decision-making in early surgical menopause which can help inform the development of a patient decision aid for this context.

Evaluating the content and development of decision aid tools for the management of menopause: A scoping review.

OBJECTIVE: Decision-making during menopause (especially surgical menopause) can be complex given the variability in risk-benefit perceptions of menopausal treatments. Decision aid tools (DATs) help women participate in decision-making about options. Our objective is to identify and evaluate the content and development of DATs for managing menopause, with a special focus on surgical menopause. METHODS: We systematically searched electronic databases, including MEDLINE and EMBASE, from inception to March 2017 for relevant records. The principal inclusion criterion was that papers reported studies on DATs for managing menopause. Search terms were derived from two concepts: menopause and DATs. Data extracted were presented in written evidence tables and narrative summaries. RESULTS: Our search yielded 18,801 records. Of these, 26 records met our inclusion criteria, which gave rise to 12 DATs from peer-reviewed literature and 6 from grey literature. Seventeen DATs were focused on natural menopause and two targeted surgical menopause, both identified from grey literature. More than half were published before the Women's Health Initiative (WHI) publication and 70% before the release of the International Patient Decision Aid Standards (IPDAS). Very few studies reported the full development of the DAT involved, and less than half of DATs were informed by a needs assessment to identify the decisional needs of their target population. Most DATs focused on hormone therapy as a treatment option and did not provide a comprehensive overview of other options. None of the DATs reported the steps involved in finding, appraising and summarizing scientific content of the tool. CONCLUSION: This review highlights several limitations in the content and development of DATs for managing menopause. No peer-reviewed DATs were identified for surgical menopause. A need for a complete, evidence-based DAT in the context of surgical menopause is identified.

The effect of hormone therapy on quality of life and breast cancer risk after risk-reducing salpingo-oophorectomy: a systematic review.

BACKGROUND: It is unclear if the use of hormone therapy (HT) in carriers of BRCA mutations improves the quality of life (QOL) without increasing the risk of breast cancer following a risk-reducing salpingo-oophorectomy (RRSO). Our objective was to assess the effect of HT on QOL and breast cancer risk, after RRSO. METHODS: We searched MEDLINE, EMBASE, CINHAL, and others, from inception to July 22, 2016, to identify relevant studies. Two reviewers independently screened identified records for controlled trials and observational studies that addressed the effect of HT on QOL and breast cancer risk in women with BRCA mutations, post RRSO. Two reviewers independently extracted data on populations, interventions, comparators, outcomes, and methodological quality. Studies addressing the same outcome were synthesized using written evidence summaries or tables. RESULTS: Of the 1,059 records identified, 13 met our inclusion criteria. All studies were observational. Six studies assessed the effect on QOL. Of these, 3 showed improvement in QOL with HT use. The risk of breast cancer was evaluated in 4 studies. The mean duration of follow-up was 2.6 years (range 0.1-19.1). The risk of breast cancer did not change with HT use in all 4 studies. CONCLUSIONS: Cumulative evidence from our review suggests that short-term HT use following RRSO improves QOL. The effect on breast cancer risk is still unclear. There are too few long-term studies to draw any strong conclusions. The need for future well-designed RCTs for more established evidence is imperative.

Beliefs about bioidentical hormone therapy: a cross-sectional survey of pharmacists.

OBJECTIVE: The aim of this study was to assess pharmacists' beliefs about bioidentical hormone therapy (BHT) and to identify factors influencing these beliefs. STUDY DESIGN: This was a cross-sectional survey of pharmacists. An email invitation to participate in the online survey was sent to a random sample of 2000 pharmacists in Alberta. The survey was accessible for a six-week period from May to July, 2011. A 54-item questionnaire was used to capture knowledge and beliefs about, and confidence in BHT. Summary statistics and multivariate regression were used for analyses. RESULTS: Overall, 401 pharmacists completed the survey (response rate 20%). Respondents were mainly female (64%), above 30 years of age (81%) and in practice for more than 10 years (63%). Only 35% of respondents correctly classified BHT as including both compounding and commercial products. In regards to beliefs, 68% of respondents agreed that BHT is as effective as non-bioidentical hormones for vasomotor symptoms, while 60% agreed BHT had equal risk. Beliefs on estriol, progesterone, and saliva testing however, were more diverse with many "do not know" responses (40%). In multivariate analysis, pharmacists who worked in pharmacies that compounded BHT were more likely to believe in BHT safety (p<0.001), and have greater confidence with BHT (p<0.001). CONCLUSIONS: Results from this survey indicated that pharmacists had varying beliefs on BHT. In addition, beliefs on the safety of BHT were associated with pharmacists' practice, specifically working in a pharmacy that compounds BHT. This study helps identify areas for targeted education.