title: Women's views of optimal risk communication and decision making in general practice consultations about the menopause and hormone replacement therapy.
abstract: Primary care consultations about the menopause and hormone replacement therapy (HRT) involve decision making in the face of clinical uncertainty. This qualitative study used focus groups and semi-structured interviews with primary care patients to explore patients' perspectives of optimal risk communication and decision making, and their views on how to improve its effectiveness. The study was set in two general practices in Cambridge, and the participants were 40 women aged between 50 and 55 years, known to be Current-Users (CU), Ex-Users (EU), or Never-Users (NU) of HRT. The majority of participants favoured communication of risks and benefits to facilitate an informed and personalised choice resulting in informed shared decision making, while some wanted a more directive approach. Women felt that risk communication would be optimised by the provision of unbiased, truthful and summarised information, and also by the personalisation of both this risk information and subsequent management of the menopause and treatment with HRT. Barriers to optimal risk communication and decision making included lack of time, GP attitudes and poor communication in the primary care consultation. In summary, consultations concerning the menopause and HRT involve complex decision making in the face of uncertainty, and most patients favour evidence-based, individualised risk information and shared decision making leading to informed choices. Some patients wish for a more directive approach, and practitioners need to develop skills to evaluate each patient's needs at each consultation.
authors.affiliation: General Practice & Primary Care Research Unit, Institute of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK. fmw22@medschl.cam.ac.uk
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
authors.forename: Margaret
authors.initials: M
authors.lastname: Rogers
authors.forename: Nicky
authors.initials: N
authors.lastname: Britten
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D003657:Decision Making; D004739:England; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000523:psychology; D005194:Family Practice / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008593:Menopause / Q000187:drug effects / Q000523:psychology; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D018579:Patient Selection; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D014930:Women / Q000193:education / Q000523:psychology*