Menopausal hormone therapy decisions: insights from a multi-attribute model.
A multi-attribute utility (MAU) decision model for menopausal hormone replacement therapy (HRT) was developed using structured interviews (n=40) to identify decision factors, and a telephone survey (n=97) to ascertain utility scores. Utility scores for individual factors and composite scores reflecting the HRT decision were compared according to HRT use. Composite utility scores (range of -1.0 to 1.0, with higher values supporting HRT use) were 0.55, -0.27, and -0.19 for the 48 HRT users, 23 former users, and 26 never users, respectively (P<0.0001). Among HRT current users, the main factors supporting use were concerns about heart disease, osteoporosis, and symptoms of menopause. Among former users, side effects weighed heavily against use, and among never users breast cancer concerns weighed heavily against use. Linear regression methods were used to identify the utilities most predictive of current HRT use. The decision model provided insight regarding how personal expectations and values influence HRT use.
Schapira
Marilyn M
MM
Department of Medicine, Clement J Zablocki VA Medical Center and the Medical College of Wisconsin, Froedtert East Office Building, Suite 4200, Milwaukee, WI 53226, USA. mschap@mcw.edu
Gilligan
Mary Ann
MA
McAuliffe
Timothy L
TL
Nattinger
Ann B
AB
D000368:Aged; D001294:Attitude to Health; D003657:Decision Making; D003661:Decision Support Techniques; D004522:Educational Status; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007044:Hysterectomy / Q000523:psychology; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D015146:Midwestern United States; D008960:Models, Psychological; D017698:Postmenopause / Q000187:drug effects / Q000523:psychology*; D011237:Predictive Value of Tests; D011788:Quality of Life; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014930:Women / Q000193:education / Q000523:psychology*; D016387:Women's Health