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How the Women’s Health Initiative (WHI) Influenced Physicians’ Practice and Attitudes

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Abstract

Background

The landmark Women’s Health Initiative (WHI) Postmenopausal Hormone Therapy Trial published in 2002 showed that the health risks of combination hormone therapy (HT) with estrogen and progestin outweighed the benefits in healthy postmenopausal women. Dissemination of results had a major impact on prescriptions for, and physician beliefs about HT. No study has fully examined the influence of the widely publicized WHI on physicians’ practice and attitudes or their opinions of the scientific evidence regarding HT; in addition, little is known about how physicians assist women in their decisions regarding HT.

Design and Participants

We conducted in-depth telephone interviews with family practitioners, internists, and gynecologists from integrated health care delivery systems in Washington State (n = 10 physicians) and Massachusetts (n = 12 physicians). Our objectives were to obtain qualitative information from these physicians to understand their perspectives on use of HT, the scientific evidence regarding its risks and benefits, and counseling strategies around HT use and discontinuation.

Approach

We used Template Analysis to code transcribed telephone interviews and identify themes.

Results

Physicians were conflicted about the WHI results and its implications. Seven themes identified from in-depth interviews suggested that the WHI (1) was a ground-breaking study that changed clinical practice, including counseling; (2) was not applicable to the full range of patients seen in clinical practice; (3) raised concerns over the impact of publicized health information on women; (4) created uncertainty about the risks and benefits of HT; (5) called for the use of decision aids; (6) influenced discontinuation strategies; and (7) provided an opportunity to discuss healthy lifestyle options with patients. As a result of the WHI, physicians reported they no longer prescribe HT for prevention and were more likely to suggest discontinuation, although many felt women should be in charge of the HT decision.

Conclusions

Physicians varied in their opinions of HT and the scientific evidence (positive and negative). Whereas the WHI delineated the risks and benefits of HT, physicians reported that decision aids are needed to guide discussions with women about menopause and HT. Better guidance at the time of WHI study publication might have been valuable to ensure best practices.

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Acknowledgments

The authors would like to thank Kelly Ehrlich, MS, Carol Brandford, and Luesa Jordan for their outstanding assistance with this study, which was supported by NIH grant no. R01 AG022578-02 (principal investigator: Dr. Newton).

Conflict of Interest

The authors have no conflict of interest to report. Preliminary results were presented at the Society for Behavioral Medicine in 2006.

Author information

Authors and Affiliations

  1. Group Health Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA

    Terry M. Bush PhD, Amy E. Bonomi PhD, MPH, Evette J. Ludman PhD, Lou C. Grothaus MA, Andrea Z. LaCroix PhD & Katherine M. Newton PhD

  2. Department of Human Development and Family Science, The Ohio State University, Columbus, OH, USA

    Amy E. Bonomi PhD, MPH

  3. Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston, MA, USA

    Larissa Nekhlyudov MD, MPH & Maureen T. Connelly MD

  4. Division of Internal Medicine, Harvard Vanguard Medical Associates, Wellesley, MA, USA

    Larissa Nekhlyudov MD, MPH & Maureen T. Connelly MD

  5. University of Washington, Seattle, WA, USA

    Susan D. Reed MD, MPH

Authors
  1. Terry M. Bush PhD
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  2. Amy E. Bonomi PhD, MPH
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  3. Larissa Nekhlyudov MD, MPH
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  4. Evette J. Ludman PhD
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  5. Susan D. Reed MD, MPH
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  6. Maureen T. Connelly MD
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  7. Lou C. Grothaus MA
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  8. Andrea Z. LaCroix PhD
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  9. Katherine M. Newton PhD
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Corresponding author

Correspondence to Terry M. Bush PhD.

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Bush, T.M., Bonomi, A.E., Nekhlyudov, L. et al. How the Women’s Health Initiative (WHI) Influenced Physicians’ Practice and Attitudes. J GEN INTERN MED 22, 1311–1316 (2007). https://doi.org/10.1007/s11606-007-0296-z

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  • DOI: https://doi.org/10.1007/s11606-007-0296-z

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