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Randomized Trial of a Portable, Self-administered Decision Aid for Postmenopausal Women Considering Long-term Preventive Hormone Therapy

Peter Tugwell

George A. Wells

Tom Elmslie

Elaine Jolly

Gary Hollingworth

Ruth Mcpherson

Elizabeth Drake

Wilma Hopman

Thomas Mackenzie

Although practice guidelines suggest that postmenopausal women learn about the benefits and nsks and consider their values when deciding about hormone therapy, the optimal decision-support method has not been established. In a randomized controlled trial, the authors compared the efficacy of a general educational pamphlet with that of a tailored decision aid. The pamphlet briefly summarized benefits, risks, and likely beneficiaries in general terms. The decision aid, delivered via booklet and audiotape, provided: detailed benefits and risks using functional terms and probabilities tailored to clinical risk; and steps for considering the issue in a woman's own situation, including a value-clarification exercise. Compared with the pamphlet group, the decision-aid group had statistically significant (p < 0.05) improvements in terms of realistic personal expectations of the benefits and nsks, decisional conflict, and perceived acceptability of the intervention. Levels of general knowledge about the main benefits and nsks were comparable for the two interventions It is concluded that tailored decision aids prepare women for decision making better than do general pamphlets. Key words: decision making; choice behavior; informed consent; decision-support techniques; woman education; woman participation; health education; consumer satisfaction; hormone replacement therapy; menopause. (Med Decis Making 1998;18:295-303)

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