Review: In Review
Women's Decision Making About the Use of Hormonal and Nonhormonal Remedies for the Menopausal Transition

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Objective:

To critically review qualitative research on women's decision making about the use of hormonal and nonhormonal remedies for the menopausal transition.

Data Sources:

Computerized searches in CINAHL, MEDLINE, Medscape, and PsychINFO databases, using the keywords decision making, hormone therapy, herbal remedies, attitude toward hormone therapy, and qualitative research; and ancestral bibliographies.

Study Selection:

Articles from indexed journals from 1982 to 2001 in the English language relevant to the keywords were evaluated. Sixteen studies met inclusion criteria and were included in the analysis.

Data Extraction:

Study findings were organized into several categories and compared and contrasted across publications and categories.

Data Synthesis:

Half of the researchers described decision making as a weighing of benefits and risks. Women's considerations, beliefs, and values, as well as interaction with the environment, were primary influences on the process.

Conclusions:

Major gaps in care for midlife women were identified. Women need information about the process of menopause and the range of available options for menopause management. Nurses can play a major role in providing information, counseling, and developing decision aids. Women's values and beliefs, cultures, life contexts, and desire for involvement in the decision should guide interventions.

Section snippets

Sampling Criteria and Process

A quest for qualitative research investigating women’s decision making for hormonal and nonhormonal therapies was conducted through computerized database searches in CINAHL, MEDLINE, PsychINFO, and Medscape, using the keywords decision making, hormone therapy, herbal remedies, attitudes toward hormone therapy, and qualitative research from 1982 to 2001; and ancestral bibliographies. Reports that were included used qualitative methods and were published in English.

A total of 16 studies published

The Decision-Making Process

Because investigators in two previous qualitative studies described how women deal with the menopausal transition as a process (Kittell, Mansfield, & Voda, 1998; Quinn, 1991), it is not surprising that other researchers (Andrist, 1998; Jones, 1999; Kittell & Mansfield, 2000; Marmoreo, Brown, Batty, Cummings, & Powell, 1998; Reece, 2002) also described decision making for hormone or nonhormonal remedies as a complex process. One important feature of this decision process is that it was

Discussion

Since 1997, there have been qualitative studies in several disciplines about menopause and decision making for HT. These studies reflect the need for in-depth knowledge about HT, mandated for counseling the large cohort of women transitioning through menopause. Lack of information about menopause and use of consumer literature as a primary source of information were found in other recent studies (Conboy, Domar, & O’Connell, 2001; George, 2002).

As a group, these qualitative studies reveal the

Implications for Practice

As educators and patient advocates, nurses are in a prime position to enhance women’s decision-making abilities, so that women can collaborate to make informed decisions. Nurses can design and develop easily understood, accessible, and unbiased sources of information about menopause, as well as tools to assist women in evaluating the risks and benefits of all options for menopause management as these apply to their individual histories, values, and preferences.

Women frequently seek information

Implications for Research

Multiple variables have been identified for future research. These include perceptions of considerations, beliefs and values, and interaction with the environment. Because decision making has been identified as a process, a grounded theory research design would further delineate the process by following women prospectively from perimenopause through menopause and include data collection at several points during the menopausal transition, as decisions evolve. Participants should include more

Conclusion

The findings from these 16 qualitative studies identified gaps in health care and menopausal counseling and highlighted needed improvements in services for this group of women. Women identified their need for information about changes in their bodies, assistance with decision making, and communication with and respect from providers. With the exception of one study (Aber et al., 1998), nurses were notably absent from discussions by the study participants. Women’s needs for information,

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