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Shared decision-making on the use of hormone therapy: a nationwide survey in the Republic of Korea

An, Ah Reum MD, MPH1; Shin, Dong Wook MD, MBA1; Chun, So Hyun MD2; Lee, Hyun-Ki MD, MPH1; Ko, Young-Jin MD3; Lee, Hyejin MD, MPH1; Son, Ki Young MD, MPH1; Choi, Ho-Chun MD1; Cho, Belong MD, MPH, PhD1; Lee, Jong-koo MD, MPH, PhD1,4,5; Kim, Jung Gu MD, PhD6

doi: 10.1097/GME.0000000000000170
Original Articles

Objective: This study aims to assess the current status of shared decision-making on instituting postmenopausal hormone therapy (HT).

Methods: Two cross-sectional nationwide surveys of postmenopausal women and primary care physicians in the Republic of Korea were conducted in 2012 via face-to-face interviews. A total of 685 women (aged 50-69 y) who with natural menopause and 250 primary care physicians were included.

Results: Only 56.8% of primary care physicians reported that they explain the benefits and risks of HT and leave the decision to postmenopausal women. The others usually recommended using or not using HT. Of those postmenopausal women who had discussed such therapy with physicians (147 of 685; 21.5%), not all were aware of breast cancer or cardiovascular risks (only 65.3% and 38.8% were informed, respectively). Although most physicians perceived HT as beneficial for menopausal symptom control (99.6%) and acknowledged the related risk of breast cancer (84.8%), nearly half had the impression that HT was preventive of cardiovascular diseases. The interviewed women were less informed of the benefits and risks of HT than were the physician respondents. The awareness levels of the treated and untreated women did not differ.

Conclusions: Participation of postmenopausal women in deciding whether to use HT is not prevalent. Physician-woman information transfer is suboptimal, and treatment decisions often are not based on the best available evidence. The current status of shared decision-making in this setting is clearly in need of improvement.

From the 1Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 2Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea; 3Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Republic of Korea; 4Department of Policy and Development, Seoul National University Hospital, Seoul, Republic of Korea; 5JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; and 6Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea.

Received August 15, 2013; revised and accepted October 24, 2013.

Funding/support: This research was supported by funding from the Korea Centers for Disease Control and Prevention (research code 800-20120075).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Jong-koo Lee, MD, MPH, PhD, Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. E-mail: docmohw@snu.ac.kr

© 2014 by The North American Menopause Society.