Structured shared decision-making using dialogue and visualization: A randomized controlled trial

Objective

The aim of this study is to evaluate a method, “Counseling in Dialogue” (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making.

Methods

94 children aged 2–12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N = 133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N = 20). 81 children had follow-up data.

Results

Compared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: −0.38 (95%CI −0.56; −0.19), p < .001; fathers: −0.22 (95%CI −0.44; −0.01), p = .045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p < 0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: −0.03 (95%CI −0.19; 0.14), p = .741).

Conclusion

The counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.     

Does motivational interviewing counseling time influence HIV-positive persons’ self-efficacy to practice safer sex?

Objective

This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA).

Methods

In 4 month intervals we followed a cohort of 490 PLWHA for 12 months.We conducted hierarchical linear regression models to examine changes in safer sex self-efficacy when participants received zero, low to moderate (5–131 min) and high (132–320 min) doses of MI time. We conducted a similar analysis using number of counseling sessions as the predictor variable.

Results

Participants with low to moderate doses of MI counseling had 0.26 higher self-efficacy scores than participants with zero MI time (p = 0.01). Also, they had 0.26 lower self-efficacy scores than participants with high amounts of MI time (p = 0.04). Participants with high doses of MI had a 0.5 higher self-efficacy score than participants with zero amount of MI time (p < 0.0001). Participants who received 3–4 counseling sessions had 0.41 greater self-efficacy scores than participants who did not receive any sessions (p < 0.0001) but did not differ from participants receiving 1–2 sessions.

Conclusion

MI time is a key to enhancing safer sex self-efficacy among PLWHA.

Practice implications

Safer sex self-efficacy improves the more MI counseling time and sessions PLWHA receive.     

Provider communication effects medication adherence in hypertensive African Americans

Objective

To evaluate the effect of patients’ perceptions of providers’ communication on medication adherence in hypertensive African Americans.

Methods

Cross-sectional study of 439 patients with poorly controlled hypertension followed in community-based healthcare practices in the New York metropolitan area. Patients’ rating of their providers’ communication was assessed with a perceived communication style questionnaire,while medication adherence was assessed with the Morisky self-report measure.

Results

Majority of participants were female, low-income, and had high school level educations, with mean age of 58 years. Fifty-five percent reported being nonadherent with their medications; and 51% rated their provider's communication to be non-collaborative. In multivariate analysis adjusted for patient demographics and covariates (depressive symptoms, provider degree), communication rated as collaborative was associated with better medication adherence (β = −.11, p = .03). Other significant correlates of medication adherence independent of perceived communication were age (β = .13, p = .02) and depressive symptoms (β = −.18, p = .001).

Conclusion

Provider communication rated as more collaborative was associated with better adherence to antihypertensive medications in a sample of low-income hypertensive African-American patients.

Practice implications

The quality of patient–provider communication is a potentially modifiable element of the medical relationship that may affect health outcomes in this high-risk patient population.     

Elevated C-reactive protein and cognitive deficits in individuals with bipolar disorder

Background

Some individuals with bipolar disorder have cognitive deficits even when euthymic. In previous studies, we found an association between elevated levels of C-reactive protein (CRP), a marker of inflammation, and reduced cognitive functioning in schizophrenia. This issue has not been examined in bipolar disorder.

Methods

We measured the levels of high sensitivity CRP in serum samples from 107 individuals with bipolar disorder. Cognitive functioning was measured with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Trail Making Test Part A and WAIS Information and Letter Number Sequencing. We estimated the odds of RBANS scores <=70 for participants whose CRP levels were above the 75th and the 90th percentile of the level of non-psychiatric controls. We also examined the association between cognitive scores and CRP levels. Covariates included demographic factors, mood symptom severity, cigarette smoking status, and body mass index.

Results

There was a significantly increased odds of low RBANS total score for individuals who had a CRP level higher than the 90th percentile (OR=4.32, p=.018) and the 75th percentile (OR=3.07, p=.04)) of the control group. There was an inverse relationship between CRP levels and performance on RBANS total (t=−2.48, p=.015); RBANS immediate memory (t=−2.16, p=.033); RBANS attention (t=−2.18, p=.032); RBANS language (t=−2.13, p=.036); Trail Making A (t=−2.39, p=.019).

Limitations

Factors which we did not measure such as diet, allergen exposure, and underlying autoimmune disorders may contribute to CRP levels.

Conclusions

Inflammation may play a major role in the cognitive deficits associated with bipolar disorder.     

Validating the Medical Data Interpretation Test in a Dutch population

Objective

To validate the Dutch translation of the Medical Data Interpretation Test.

Methods

A test–retest design with a 2-week interval was used.

Results

The intraclass correlation coefficient (ICC = .82), the limits-of-agreement interval (LOA = −8.96 to 2.48) and the test–retest reliability (Pearson's r = 86) suggest that the Dutch translation has good reproducibility. Construct validity was tested by two hypotheses, both of which were confirmed. University participants had higher test scores than non-university participants (p = .02), and males did not score differently than females (p = .61).

Conclusion

The results suggest that the Dutch version of the Medical Data Interpretation Test is an adequate scale to assess ability to interpret medical data.

Practice implications

Assessing patients’ numeracy skills before a counseling session will enable the counselor to adjust subsequent communication accordingly and, as such, improve the session's effectiveness.     

Bridging the transition from cancer patient to survivor: Pilot study results of the Cancer Survivor Telephone Education and Personal Support (C-STEPS) program

Objective

To develop a feasibility study of a theory-driven telephone counseling program to enhance psychosocial and physical well-being for cancer survivors after treatment.

Methods

Participants (n = 66) were recruited from two Colorado hospitals with self-administered questionnaires at baseline and two weeks post-intervention. The one group, intervention only design included up to six thematic telephone counseling sessions over three months. Topics included nutrition, physical activity, stress management, and medical follow-up. Primary outcomes were cancer-specific distress, self-reported fruit and vegetable consumption and physical activity.

Results

Of 66 subjects, 46 completed at least one counseling module and the follow-up assessment (70% retention rate). Mean satisfaction was 9 out of 10, and all participants would recommend C-STEPS to other survivors. Cancer-specific distress (Impact of Event Scale – Intrusion subscale) decreased for entire study population (p < 0.001) and stress management session participants (p < 0.001). Fruit and vegetable consumption increased for nutrition and exercise session participants (p = 0.02) and the entire sample (p = NS). Physical activity increased in the entire group (p = 0.006) and for nutrition and exercise session participants (p = 0.01).

Conclusion and practice implications

C-STEPS is a feasible telephone counseling program that transcends geographic barriers, demonstrating the potential to decrease distress and promote coping and healthy lifestyles among cancer survivors.     

Patient communication tools to enhance ART adherence counseling in low and high resource settings

Objective

Few articles have examined specific counseling tools used to increase antiretroviral therapy (ART) adherence. We present communication tools used in the context of Project MOTIV8, a randomized clinical trial.

Methods

We developed, piloted, and evaluated pictorial images to communicate the importance of consistent dose timing and the concept of drug resistance. Electronic drug monitoring (EDM) review was also used to provide visual feedback and facilitate problem solving discussions. Adherence knowledge of all participants (n = 204) was assessed at baseline and 48 weeks. Participant satisfaction with counseling was also assessed.

Results

Adherence knowledge did not differ at baseline, however, at 48 weeks, intervention participants demonstrated significantly increased knowledge compared to controls F(1, 172) = 10.76, p = 0.001 (12.4% increase among intervention participants and 1.8% decrease among controls). Counselors reported that the tools were well-received, and 80% of participants felt the counseling helped them adhere to their medications.

Conclusions

Counseling tools were both positively received and effective in increasing ART adherence knowledge among a diverse population.

Practice implications

While developed for research, these counseling tools can be implemented into clinical practice to help patients; particularly those with lower levels of education or limited abstract thinking skills to understand medical concepts related to ART adherence.     

Physicians’ reactions to uncertainty in the context of shared decision making

Objective

Physicians’ reactions towards uncertainty may influence their willingness to engage in shared decision making (SDM). This study aimed to identify variables associated with physician's anxiety from uncertainty and reluctance to disclose uncertainty to patients.

Methods

We conducted a cross-sectional secondary analysis of longitudinal data of an implementation study of SDM among primary care professionals (n = 122). Outcomes were anxiety from uncertainty and reluctance to disclose uncertainty to patients. Hypothesized factors that would be associated with outcomes included attitude, social norm, perceived behavioral control, intention to implement SDM in practice, and socio-demographics. Stepwise linear regression was used to identify predictors of anxiety from uncertainty and reluctance to disclose uncertainty to patients.

Results

In multivariate analyses, anxiety from uncertainty was influenced by female gender (β = 0.483; p = 0.0039), residency status (1st year: β = 0.600; p = 0.001; 2nd year: β = 0.972; p < 0.001), and number of hours worked per week (β = −0.012; p = 0.048). Reluctance to disclose uncertainty to patients was influenced by having more years in formal education (β = −1.996; p = 0.012).

Conclusion

Variables associated with anxiety from uncertainty differ from those associated with reluctance to disclose uncertainty to patients.

Practice implications

Given the importance of communicating uncertainty during SDM, measuring physicians’ reactions to uncertainty is essential in SDM implementation studies.     

Patient activation,depression and quality of life

Objective

“Patient activation” describes the extent to which individuals manage their own healthcare. This study evaluated the association of patient activation, depressive symptoms and quality of life in a primary care setting.

Methods

278 patients who visited two primary care clinics were interviewed in the waiting room before their appointment or by telephone. Study participants completed the Patient Activation Measure (PAM), Patient Health Questionnaire-9 (PHQ-9) and Short Form-12 Health Survey (SF-12). Physicians assessed each participant's depression status immediately after the visit.

Results

PAM scores correlated negatively with PHQ-9 (r = −0.35, p < 0.0001) and positively with total SF-12 score (r = 0.39, p < 0.0001). Increased participant involvement by one-level increments on the PAM was predicted by their being in the 55 to 74-year age group and higher total SF-12 quartiles. Almost half of those scoring ≥10 on PHQ-9 were not considered depressed by their physician (false negatives, i.e. “hidden depression”).

Conclusion

In primary care settings, PAM is easily administered and useful for general patients and for those with depressive symptoms.

Practice implications

Assessing patient activation will enable caregivers to monitor levels of self-care (activation) and potential adherence to health behavior recommendations. PHQ-9 screening could increase awareness of “hidden depression” in the primary care setting.     

Glycemic control in young children with diabetes: The role of parental health literacy

Objective

This cross sectional study examined the relationship between parental health literacy (HL), diabetes related numeracy, and parental perceived diabetes self-efficacy on glycemic control in a sample of young children with Type 1 DM.

Methods

Seventy primary caregivers of children (age 3–9 years) with Type 1 DM were recruited and surveyed at diabetes outpatient clinic visits. Patients’ medical histories were obtained by medical chart review.

Results

Parental diabetes related numeracy (r = −.52, p < 01), but not reading skills (r = −.25, p = NS) were inversely correlated with the child's glycemic control (HbA1c). Parental perceived diabetes self-efficacy was also negatively correlated to their child's HbA1c (r = −.47, p < 01). When numeracy and parental perceived diabetes self-efficacy were included as predictors of HbA1c, the model was significant (F = 12.93, p < .01) with both numeracy (β = −.46, p < .01) and parental perceived diabetes self-efficacy (β = −.36, p = .01) as significant predictors of HbA1c.

Conclusions

Data from this study highlight the importance of considering the role of parental numeracy, in health outcomes for children with Type 1 DM.

Practice implications

Practitioners should assess parental health literacy and consider intervention when needed.     

Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: Rationale,design, methodology,prevalence and attributes

Background

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.

Objectives

To determine the prevalence and attributes of frailty in institutionalized Spanish older adults.

Design

Cross-sectional analysis of basal data of a concurrent cohort study.

Setting

Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.

Participants

331 institutionalized adults older than 65 years.

Measurements

Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ² tests, t-Student and logistic regression.

Results

Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p < 0.001), and frail participants were older (85.1 vs. 82.3; p < 0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2–6.2), Barthel index (OR 2.2 95%CI 1.2–4.4), depression risk (OR 2.2 95%CI 1.0–4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6–0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8–4.5) and emergency visits (OR 1.5 95%CI 0.7–3.2) in the previous 6 months.

Conclusion

In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.     

Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

Objectives

This study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.

Methods

We use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.

Results

Results show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.

Conclusion

These results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.

Practice implications

We therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.     

Association of bone mineral density with postural stability and the fear of falling in Spanish postmenopausal women

Objective

The purpose of our study was to investigate the relationship between bone mineral density (BMD) and postural stability and the fear of falling in a 50- to 65-year-old postmenopausal population.

Study design

A cross-sectional, observational study was conducted on 118 postmenopausal women. According to their BMD values, participants were divided into two groups: BMD > −2.0 SD (n = 95) and ≤−2.0 SD (n = 23).

Main outcome measures

Postural stability, assessed with a resistive multi-sensor platform, fear of falling (FoF) and the history of falls in the last 12 months were investigated.

Results

Women with BMD ≤ −2.0 SD reported a significantly increased FoF when compared to women with BMD > −2.0 SD (P = 0.024, η² = 0.045, 1 − β = 0.624). In the postural stability analysis, the group with BMD ≤ − 2.0 SD showed, under the eyes-open condition, statistically significantly higher values for the velocity (VEO) (P = 0.040, η² = 0.037, 1 − β = 0.539) and the anteroposterior mean displacement of the center of pressure (YEO; P = 0.017, η² = 0.049, 1 − β = 0.669). No significant differences between groups were observed in the history of falls or in the rest of the stabilometric analyses.

Conclusions

In Spanish postmenopausal women under 65 years, a BMD ≤ −2.0 SD is significantly associated with postural instability (elevated VEO and XEO) and an increased FoF, which are two highly influential factors in the risk of falling.     

Leukocyte telomere length is independently associated with gait speed in elderly women

Objectives

Declining gait speed is common in the elderly population and is associated with age-related conditions. Because telomere length is a reflection of aging and known to affect degenerative changes in organ systems, gait speed may be associated with telomere length. We therefore investigated the relationship between gait speed and leukocyte telomere length in elderly Korean women.

Study design

Cross-sectional study.

Main outcome measures

A total of 117 Korean elderly women participated. Metabolic variables were assessed along with gait speed calculated as walking distance (6 m) divided by time. Leukocyte telomere length was measured by real-time quantitative polymerase chain reaction.

Results

Gait speed correlated with telomere length (r = 0.38, p < 0.01), fasting insulin (r = −0.19, p = 0.04), homeostasis model assessment of insulin resistance index (HOMA-IR; r = −0.22, p = 0.02), triglyceride (r = −0.20, p = 0.03), and Korean Mini-Mental State Examination (K-MMSE; r = 0.20, p = 0.03) after adjusting for age. On step-wise multiple regression analysis, telomere length (β = 0.35, p < 0.01), K-MMSE (β = 0.16, p = 0.02), age (β = −0.23, p = 0.01), and HOMA-IR (β = −0.19, p = 0.03) were identified as independent variables associated with gait speed.

Conclusions

This study suggested that telomere length may have a role in maintaining overall health status as well as preserving gait speed in the elderly population. Further studies are required to better understand the significance of our findings.     

Relationship of stimulated saliva 17β-estradiol and oral dryness feeling in menopause

Objectives

The aim of this study was to compare stimulated whole saliva 17β-estradiol of menopausal women with/without oral dryness (OD) feeling, and evaluate the relationship between saliva 17β-estradiol and severity of OD feeling.

Methods

A case-control study was carried out in 76 selected menopausal women aged 41–77 years with or without OD feeling (38 as case and 38 as control) conducted at the Clinic of Oral Medicine, Tehran university of medical sciences. Paraffin-stimulated saliva samples were obtained by expectoration. Xerostomia inventory (XI) score was used as an index of OD feeling severity. The saliva 17β-estradiol concentration was measured by ELISA. Statistical analysis of Student's t-test and Spearman correlation was used.

Results

No significant difference was found in stimulated whole saliva flow rate between the two groups, but the mean concentration and output of saliva 17β-estradiol were significantly lower in case than control. There was significant negative correlation between XI score and stimulated whole saliva concentration (r = −0.391, P = 0.004) and output (r = −0.302, P = 0.002) of 17β-estradiol in menopausal women.

Conclusions

It seems that there is a negative correlation between OD feeling severity and stimulated whole saliva 17β-estradiol in menopausal women.     

Bolstering confidence in obesity prevention and treatment counseling for resident and community pediatricians

Objective

To assess whether equipping resident pediatricians and community pediatricians with both training and practical tools improves their perceived confidence, ease, and frequency of obesity-related counseling to patients.

Methods

In 2005–2006, resident pediatricians (n = 49) and community pediatricians (n = 18) received training regarding three evidence-based obesity prevention/treatment tools and responded to pre- and post-intervention questionnaires. We analyzed changes in reported mean confidence, ease, and frequency of dietary, physical activity, and weight status counseling.

Results

Baseline scores of confidence, ease, and frequency of counseling were higher in community pediatricians than residents. Mean scores increased significantly in the combined group, among residents only, and trended towards improvement in the community pediatricians following the intervention. Means for “control” questions were unchanged.

Conclusion

Training and tools for residents and community pediatricians improved their confidence, ease, and frequency of obesity-related counseling.

Practice implications

This study demonstrates that when feasible and appropriate tools and training were provided through a simple intervention, physicians gained confidence and ease and increased their counseling frequency. The results here suggest that widespread implementation of such educational interventions for community practitioners and practitioners in training could change the way physicians counsel patients to prevent the often frustrating problem of childhood obesity.     

Literacy-appropriate educational materials and brief counseling improve diabetes self-management

Objective

In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care.

Methods

We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients’ activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up.

Results

Statistically significant (p ≤ 0.001) and clinically important (effect sizes = 0.29–0.42) improvements were observed in participants’ activation, self-efficacy, diabetes-related distress, self-reported behaviors, and knowledge. Improvements were similar across literacy levels. Spanish speakers experienced both greater improvement in diabetes-related distress and less improvement in self-efficacy levels than English speakers.

Conclusion

A diabetes self-management support package combining literacy-appropriate patient education materials with brief counseling suitable for use in primary care resulted in important short-term health-related psychological and behavioral changes across literacy levels.

Practice implications

Coupling literacy-appropriate education materials with brief counseling in primary care settings may be an effective and efficient strategy for imparting skills necessary for diabetes self-management.     

The effects of two health information texts on patient recognition memory: A randomized controlled trial

Objective

To compare the effects of two health information texts on patient recognition memory, a key aspect of comprehension.

Methods

Randomized controlled trial (N = 60), comparing the effects of experimental and control colorectal cancer (CRC) screening texts on recognition memory, measured using a statement recognition test, accounting for response bias (score range −0.91 to 5.34). The experimental text had a lower Flesch–Kincaid reading grade level (7.4 versus 9.6), was more focused on addressing screening barriers, and employed more comparative tables than the control text.

Results

Recognition memory was higher in the experimental group (2.54 versus 1.09, t = −3.63, P = 0.001), including after adjustment for age, education, and health literacy (β = 0.42, 95% CI: 0.17, 0.68, P = 0.001), and in analyses limited to persons with college degrees (β = 0.52, 95% CI: 0.18, 0.86, P = 0.004) or no self-reported health literacy problems (β = 0.39, 95% CI: 0.07, 0.71, P = 0.02).

Conclusion

An experimental CRC screening text improved recognition memory, including among patients with high education and self-assessed health literacy.

Practice implications

CRC screening texts comparable to our experimental text may be warranted for all screening-eligible patients, if such texts improve screening uptake.     

Working alliance in communication skills training for oncology clinicians: A controlled trial

Objective

The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance.

Methods

Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N = 56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N = 57) who did not benefit from CST. The patient–clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory – Short Revised Form.

Results

While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance.

Conclusion

Patient–clinician alliance is related to specific verbal communication behaviors.

Practice implications

Working alliance is a key element of patient–physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.     

Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: A randomized controlled trial

Objective

To evaluate the effects of escitalopram 10–20 mg/day on menopause-related quality of life and pain in healthy menopausal women with hot flashes.

Study design

A double-blind, placebo-controlled randomized trial of escitalopram 10–20 mg/day vs. identical placebo was conducted among 205 women ages 40–62 years with an average of ≥4 daily hot flashes recruited at 4 clinical sites from July 2009 to June 2010.

Main outcome measures

The primary trial outcomes, reported previously, were the frequency and severity of vasomotor symptoms at 8 weeks. Here, we report on the pre-specified secondary endpoints of total and domain scores from the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the pain intensity and interference scale (PEG).

Results

Outcome data were collected on 97% of randomized women and 87% of women took at least 70% of their study medication. Treatment with escitalopram resulted in significantly greater improvement in total MENQOL scores (mean difference at 8 weeks of −0.41; 95% confidence interval (CI) −0.71 to −0.11; p < 0.001), as well as Vasomotor, Psychosocial, and Physical domain scores with the largest difference seen in the Vasomotor domain (mean difference −0.75; 95% CI −1.28 to −0.22; p = 0.02). There was no significant treatment group difference for the Sexual Function domain. Escitalopram treatment resulted in statistically significant improvements in PEG scores compared to placebo (mean treatment group difference at 8 weeks of −0.33; 95% CI −0.81 to 0.15; p = 0.045).

Conclusions

Treatment with escitalopram 10–20 mg/day in healthy women with vasomotor symptoms significantly improved menopause-related quality of life and pain.