Women prefer GPs to the Internet when trying to find out about HRT

Main Category: Public Health
Article Date: 22 Aug 2003 - 0:00 PDT

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Contact: Anna Hinds
anna.hinds@esrc.ac.uk
01793-413122
Economic & Social Research Council

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Recent media reports are littered with headlines such as these. What impact are such headlines likely to have on women considering, or currently taking, hormone replacement therapy (HRT) and where will they turn for further information and advice?

A study jointly funded by the Economic and Social Research Council (ESRC) and the Medical Research Council (MRC) suggests that, without significant policy rethinking, GPs are likely to remain the most important source of information and advice to women, despite increasing access to sources of health information like the Internet.

The study investigated the processes by which women found out about HRT and its risks and benefits. In particular, the study identified the main concerns women had about risks, their main sources of information, their interpretations of what they found, and how this fed into their decision-making to take HRT or not.

Thirty-two mid-life women, all of whom had been prescribed HRT, were recruited through a GP practice or gynaecological clinic. Sixteen of these were followed up over a period of a year to assess the significance of changed health status or new research and/or media reports on their approach to information seeking regarding HRT risks. Health care professionals (GPs, obstetrics and gynaecology consultants) consulted by a sub-group of women were also interviewed, and observations of consultations between doctors and patients were also made.

The study focused on the debate concerning 'patient involvement' in the health service, now a major strand of government health policy. A key aspect of this is the extension of 'informed choice', where patients are supposed to take a more central role in decision-making about their health treatment options and other aspects of health care. New media services such as NHS Direct (telephone and online services), and the Internet more generally, are seen as supporting the emergence of new 'informed patients' who will engage in more equitable relationships with health care professionals in the process of decision-making.

The study investigated the processes by which this particular group of women became 'informed' about HRT. It has identified several key constraints on the emergence of the 'informed patient' and the practice of 'informed choice':

• Many women are still reluctant to take the responsibility implied by the notion of the informed patient/informed choice and are happy to rely on advice from their GP and other health professionals
• Those that do seek to inform themselves often find they have insufficient 'information literacy' to manage and interpret what they find - this is especially the case when trying to navigate the world wide web
• Those that successfully manage information and come to form a view about preferred treatment approaches often find their preferences dismissed or ridiculed by their doctors who encourage women to take HRT
• Many health professionals resist the development of more informed patients, either because their authority is being challenged or because they fear they won't be able to cope with the extra demands made by such patients

The study has major implications for health policy in the field of consumer health information. 'Everyone may well have a 'right' to information,' says Dr Fils Henwood, 'but if they are reluctant to take the responsibility implied by that right, then the policy and practice of informed choice is doomed to fail.'

'Most treatments incur some risks - if patients are fully informed and engaged in decision-making, as opposed to placing trust in doctors and letting them decide, then they are also culpable when things go wrong,' she continues.

'This is good news for the medical profession but it may be something for which the wider public is not yet ready.

'If the government is really committed to the development of more informed patients, it has to recognise the need for more resources to be put into the development of appropriate information literacy skills, especially those associated with Internet use.

'In addition, health care professionals' education and training will need to change in ways that enable them to embrace, rather than resist, the emergence of new informed patients. This may well include the development of a less authoritative relationship with patients and a greater honesty about how government health policy and resource constraints influence the advice they give.'