An Underutilized Resource: Patient Portals for Menopause Shared Decision Making (Preprint)

BACKGROUND Perimenopausal women would benefit from a better understanding of perimenopause, associated conditions, and appropriate therapy, to promote shared decision-making (SDM) conversations with their providers regarding menopause. We implemented a pilot educational intervention called “My HealtheVet to Enable And Negotiate for Shared decision-making” (MEANS) using the Veterans Affairs (VA) patient portal My HealtheVet (MHV), in the Miami VA Healthcare System (VAHS). Intervention participants received weekly secure messages with information on perimenopause, symptoms, and treatment. OBJECTIVE Assess the effect of the MEANS intervention on knowledge and SDM regarding menopause, and program satisfaction. METHODS We enrolled 128 women from the Miami VAHS, of which 91 participated in the six-month intervention and completed the baseline and end-of-study questionnaire. Participants’ (n=91) average age was 54.0±4.2 years; 42 (46.2%) White, (46.2%) Black, and 65 (71.4%) Non-Hispanic; 57 (62.6%) had a college degree or higher. We conducted within-group comparisons at the end of the six-month intervention, using paired t-tests and chi-squared tests as appropriate. RESULTS Participants’ average scores on a menopause knowledge questionnaire increased from 80.9% to 87.2% post-intervention (p<0.01). Post-intervention, 40 of 91 (44.0%) reported MEANS allowed them to get information that would otherwise would have been difficult to obtain, 68 (74.7%) said it increased their understanding of menopause and its treatments, 68 (74.7%) felt more confident to discuss these treatments with their provider, 35 (38.5%) reported they had discussed hormone therapy with their provider, and many had adopted new positive health behaviors. There was a significant increase in self-reported use of secure messaging (SM) to discuss menopausal symptoms with their doctor, from 14 (15.4%) to 34 (37.4%) (p<0.01). CONCLUSIONS This pilot intervention shows that patient portals may offer a feasible and scalable tool to enhance communication and SDM regarding menopause, by improving knowledge among racially and ethnically diverse women. This modality may also be useful for other non-emergent conditions. CLINICALTRIAL NCT03109145