Acceptability of a companion patient guide to support expert consensus guidelines on surveillance mammography in older breast cancer survivors.

PURPOSE: To support shared decision-making, patient-facing resources are needed to complement recently published guidelines on approaches for surveillance mammography in breast cancer survivors aged ≥ 75 or with < 10-year life expectancy. We created a patient guide to facilitate discussions about surveillance mammography in older breast cancer survivors. METHODS: The "Are Mammograms Still Right for Me?" guide estimates future ipsilateral and contralateral breast (in-breast) cancer risks, general health, and the potential benefits/harms of mammography, with prompts for discussion. We conducted in-clinic acceptability testing of the guide by survivors and their clinicians at a National Cancer Institute-designated comprehensive cancer center, including two community practices. Patients and clinicians received the guide ahead of a clinic visit and surveyed patients (pre-/post-visit) and clinicians (post-visit). Acceptability was defined as ≥ 75% of patients and clinicians reporting that the guide (a) should be recommended to others, (b) is clear, (c) is helpful, and (d) contains a suitable amount of information. We also elicited feedback on usability and mammography intentions. RESULTS: We enrolled 45 patients and their 21 clinicians. Among those responding in post-visit surveys, 33/37 (89%) patients and 15/16 (94%) clinicians would recommend the guide to others; 33/37 (89%) patients and 15/16 (94%) clinicians felt everything/most things were clear. All other pre-specified acceptability criteria were met. Most patients reported strong intentions for mammography (100% pre-visit, 98% post-visit). CONCLUSION: Oncology clinicians and older breast cancer survivors found a guide to inform mammography decision-making acceptable and clear. A multisite clinical trial is needed to assess the guide's impact mammography utilization. TRIAL REGISTRATION: ClinicalTrials.gov-NCT03865654, posted March 7, 2019.

Menopausal symptom management and prevention counseling after the Women's Health Initiative among women seen in an internal medicine practice.

OBJECTIVE: To describe the management of menopausal symptoms and the prevalence of prevention counseling among women who stopped hormone therapy (HT) after publication of the initial findings of the Women's Health Initiative. METHODS: Telephone survey between July and September 2003 of 142 women 50 years and older, randomly selected from a large academic primary care practice, who stopped taking HT after the WHI publication, July 9, 2002 (66% response rate). RESULTS: Among 142 women, the median age was 60 years, 63% were white, 52% had at least a college degree, and 60% were taking estrogen and progestin as of July 9, 2002. The majority (82%, n = 117) who stopped HT suffered some menopausal symptom: 25 restarted HT, 13 received another prescription medication, and 56 tried at least one complementary and alternative medicine. Women most commonly used soy (n = 40) or black cohosh (n = 25) for their symptoms, although less than one third of women found either of these treatments effective. Only 49% (57 of 117) of women with symptoms visited a doctor for their symptom. Few women reported receiving counseling about prevention topics after the WHI, such as risk of osteoporosis (34%), risk of heart disease (26%), diet (41%), and exercise (45%). CONCLUSIONS: Most women who stopped HT after the WHI experienced some menopausal symptoms. Few women found commonly used alternative medicines effective, and few received other prescription medications. Counseling about osteoporosis and heart disease risk was infrequent after the WHI. Future studies should focus on finding safe and effective therapies for menopausal symptoms.