Study On The Quality Of Shared Decision-Making In Menopausal Hormone Therapy For Perimenopause Women

Background:As the medical model shifts towards the "bio-psycho-social" approach and patients’awareness of their rights increases,the concept of patient-centered care has been gradually integrated into the medical system,and the shared decision-making(SDM)model between doctors and patients has gained the attention of healthcare providers.Menopausal hormone therapy(MHT)is the first-line treatment for menopause syndrome.Its application is affected by not only risks and benefits factors,but also perimenopause women’s own preferences and needs.Therefore,it is necessary to make reasonable medical decisions based on objective medical evidences and women’s needs.Objective:To describe the current status of SDM quality in MHT in China and analyze factors that affect it,this study combines quantitative research with qualitative analysis based on the concept of shared decision-making.It urther explores reasons behind decisions made by perimenopause women through interviews.The aim is to provide theoretical basis for achieving better clinical care for menopause women and help them improve quality of life in old age.Methods:This study used a combination of questionnaire survey and semi-structured interview methods.Convenience sampling was used to select perimenopause women who were undergoing menopausal hormone therapy from Center for Gynecological Endocrinology of a top hospital in Beijing.A self-designed questionnaire and the Chinese version of 9-items shared decision making questionnaire(SDM-Q-9)were used for SDM quality research.In semi-structured interview,a self-designed interview outline was used.The interview content included women’s understanding of the decision-making process,attitudes towards medical information,factors influencing hormone use,etc.The data collected from the questionnaire were imported into SPSS 26.0 for statistical analysis using non-parametric tests and multiple linear regression.The recorded interviews were transcribed into text and imported into Nvivo 12.0 for analysis using the Colaizzi seven-step analysis method.Results:109 questionnaires were collected,and 101 valid questionnaires were obtained,with an effective rate of 92.7%.The SDM quality score in this study was(89.75 ±10.012).The average age of women was(53±5.92)years old,ranging from 41 to 73 years old.Women using continuous combined therapy(54.5%)were slightly more than those using sequential therapy(41.6%),and most women believed that MHT was effective(88.1%).The top three symptoms detected were hot flashes and sweating(68.3%),insomnia(52.5%),and joint pain(32.7%).The top three social and psychological factors were doctor’s recommendation for use(30.7%),fear of aging quickly(19.8%),and desire to continue menstruation(16.8%).Univariate analysis showed that fertility status,hot flashes and sweating,insomnia,mood swings,perceived treatment effectiveness,and doctor’s recommendation for use were all factors affecting SDM quality(P<0.05).Multiple linear regression results showed that fertility status(β=0.262,P=0.005),hot flashes and sweating(β=0.194,P=0.044),insomnia(β=0.227,P=0.017),and doctor’s recommendation for use(β=0.206,P=0.025)could explain 23.7%of the variation in SDM quality.The average age of the 10 interviewed women was(55±9.30)years old.Four of them used a sequential therapy,while six used a continuous combined therapy.The majority of hormone therapy use was within 5 years(70%),with the longest duration being 22 years.Based on the interview results,nine sub-themes were extracted and summarized into three main themes:perimenopause women tend to have decision-making led by doctors,hormone therapy use is influenced by several factors,and treatment satisfaction affects medical experience.Conclusions:Perimenopausal women have a higher willingness to participate in decision-making,and doctors need to clearly guide decision-making behavior.Decisions made under the guidance of doctors have achieved better treatment outcomes.There is a difference between willingness to participate in decision-making and actual participation,and it is necessary to explore decision-making models that are more suitable for women undergoing MHT.It is recommended to further promote SDM theoretical research,improve the accessibility of MHT and the role of community management.