Joachim P Sturmberg
Medical news often receives intense, but distorted, media coverage,
which can lead to high levels of insecurity in both patients and
To elicit general practitioners’ self reported behaviour regarding
hormone therapy (HT) advice and prescribing, before, immediately
after, and 2 years following the release of the first results of the
combined oestrogen and progesterone arm of the Women’s Health
Initiative (WHI) study; to elicit GPs’ understanding of statistical risk
terminology; and to explore their personal preferences relative to the
trade offs between quality and length of life in medical treatment.
In October 2004, a questionnaire was sent to all 169 GPs working on
the central coast of New South Wales.
The response rate was 67.5%. Before the release of the WHI study,
43.8% of GPs recommended HT; 5.9% did so immediately after, and
1.8% 2 years later. When expressed as number needed to treat (NNT),
20.8% of GPs stated that they were unable to interpret the absolute
risk of HT use. Half of the 84 GPs who stated that they understood the
concept of NNT were not going to reconsider the advice to give HT.
General practitioners with a personal preference toward length of
life over quality of life proved to be significantly more likely to advise
against HT use (p=0.008 in a group comparison).
The sensationalising of the disease specific mortality differences
in HT users had a dramatic and lasting effect on GPs’ attitudes to,
and prescribing of, HT. General practitioners acknowledged their
poor understanding of basic statistical risk terminology. Providing
absolute risk terms did not alter clinical decision making in 50% of
GPs, clinical decision making may well be more powerfully influenced
by a doctor’s personal preferences relative to the trade off between
quality and quantity of life.
The intense media coverage following the Women’s Health Initiative (WHI) study1 on the risks and benefits of combined oestrogen and progesterone hormone therapy (HT) in July 2002 alarmed patients and general practitioners alike.
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