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Oct 1, 2019

ESGO 2019

Hormone replacement therapy for BRCA-mutation carriers: attitudes of Israeli health-care providers before and after a brief educational intervention

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Hormone replacement therapy

BRCA-mutation carriers

educational intervention

RISK REDUCING SALPINGO OOPHORECTOMY

Abstract

Abstract

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Keywords

Hormone replacement therapy

BRCA-mutation carriers

educational intervention

RISK REDUCING SALPINGO OOPHORECTOMY

Abstract

OBJECTIVE BRCA mutation carriers are offered risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 35−40 years, leading to major life-quality and health-related issues associated with early menopause. Hormone replacement therapy (HRT) may significantly alleviate menopausal symptoms without increasing breast or ovarian cancer risk in BRCA carriers. We investigated attitudes of Israeli health-care providers to HRT post-RRBSO in BRCA carriers, before and after a brief educational intervention. METHODS In this pre−post survey of gynecologic departments in Israel, health-care providers were given questionnaires (based on scores of 1−4) assessing attitudes to prescribing HRT in different clinical scenarios, before and after an educational intervention on current knowledge about HRT in BRCA-mutation carriers. Higher scores indicated higher tendency to prescribe HRT. Mean score was calculated for each scenario and the association between scores and various health-care providers' characteristics was assessed. The change in attitude pre- vs. post-intervention was evaluated. RESULTS Of the 200 health care providers who were offered participation, 162 responded. Of them, 25.3% were obstetricians, 13.6% gynecologists, 5.55% gynecologic-oncologists, 8% oncologists, 38.9% Obstetrics-gynecology residents and 8.6% were nurses. Median age was 44 (IQR 36−58); 42.6% were males. Higher score correlated weakly with older age, but did not correlate with gender or personal HRT/menopause experience. Significantly higher mean pre-intervention scores were obtained by gynecologists (3.33±0.93) and gynecologic-oncologists (3.6±0.78) than by oncologists, obstetricians, residents or nurses (2.59±1.06, 2.7±1.09, 2.48±0.99, and 2.2±0.92, respectively). Overall scores were higher post-intervention (p<0.001). The change in scores post intervention was most prominent among younger participants and nurses. CONCLUSIONS In Israel, it is acceptable to offer HRT post-RRBSO to healthy BRCA-mutation carriers. Younger health care workers and nurses tend to be more hesitant, yet they are more likely to adopt a pro-HRT attitude after an educational intervention. Such intervention is likely to improve overall care for BRCA-mutation carriers.

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© Copyright 2019 Morressier GmbH.
All rights reserved.