Impact of pharmacist consultation versus a decision aid on decision making regarding hormone replacement therapy

Objective To compare the effects of pharmacist consultation versus a decision aid on women's decisional conflict regarding use of hormone replacement therapy (HRT) and subsequent satisfaction with the decision-making process. Setting A family medicine clinic in Canada. Method The study was a prospective, randomised comparative trial. Peri- and post-menopausal female patients aged 48 to 52 years were invited to participate. Volunteers (n=128) received either a private consultation with a pharmacist or a take-home decision aid. Data collection was undertaken prior to the intervention and again following an appointment with a physician to discuss HRT. Outcome measures included: perception of being informed about HRT, decisional conflict, satisfaction with the education and the decision made regarding HRT, and adherence to HRT if prescribed. Telephone follow-up occurred three and 12 months after the physician appointment. Key findings After discussing HRT with their physicians, 35 of 91 women (38.5%) chose HRT, 15 (16.5%) declined it and 41 (45.1%) opted to delay their decision. Both interventions significantly increased women's perception of being informed about this form of therapy and decreased decisional conflict. Satisfaction with the education and with the HRT decision was high. More postmenopausal women in the pharmacist group reached a yes/no decision than in the decision aid group. Of those initiating HRT during the study (n =18), 16.7% had discontinued it at 12 months. Conclusion Consultation with a pharmacist and use of a decision aid are both effective methods for decreasing decisional conflict in peri- and post-menopausal women considering HRT.