Grant: Project Grant - PA: Patient-Oriented Research - Health equity-focused iCT

Nudges and facilitated relay are evidence-based strategies to influence patient and clinician behaviour. However, whether and how they impact prescribing of guideline-recommended medications like menopause hormone therapy (MHT) remains unknown. Despite menopause causing significant impacts across females' lives, use of MHT remains sub-optimal. After publication of the Women's Health Initiative study in 2002, MHT use dramatically declined from a peak of 40% of menopausal females. Today only 9.5% of menopausal females in Canada report using MHT. This study is essential to determine the effect of behavioural interventions on uptake of MHT and could counteract the persistent undertreatment of menopause symptoms. We will conduct a two-arm, parallel-group pragmatic randomized controlled trial to evaluate the impact of a combined patient and provider-targeted strategy on increasing MHT prescribing compared to usual care. Women aged 45-59 without an active MHT prescription in the intervention arm will receive a nudge letter informing them about menopause and MHT, along with a facilitated relay letter to bring to their primary care provider. Nudges guide decision-making while preserving choice, and facilitated relay improves provider-patient communication. Together these evidence-based strategies aim to increase informed MHT discussions and prescribing. The primary outcome is number of MHT prescriptions up to 12 months after the letters are sent. The intervention is expected to increase MHT prescription by at least 3%, reduce the burden of menopause symptoms, and improve women's quality of life. This research will generate robust evidence on both patient and provider-oriented strategies to increase prescribing of MHT to address the unmet needs of midlife females and simultaneously reducing gender-related health inequities.