Hormone replacement therapy in the menopause. Structure and content of risk talk.
OBJECTIVE
To investigate how risks and benefits of hormone replacement therapy (HRT) are communicated to women in clinical practice. To evaluate the usefulness of a risk classification based on context framing, i.e. whether the risk is discussed for one or several alternative treatments, and/or in the same context as possible benefits.


METHODS
Analysis of structure and content of transcribed consultations (n = 20) from first-time visits for discussion of climacteric discomfort and/or HRT with five physicians at three different out-patient clinics of gynecology.


RESULTS
All women received a prescription of HRT. An alternative to HRT was discussed in seven of the consultations. No decision aids were used. Risk discussion was dominated by the physicians giving information about long-time risk and benefits. The decision to prescribe was made either before the risk discussion was initiated, or before it was finished, in 8 of the 18 consultations where risk discussion was present. Risk classification according to context framing was performed and indicated use of different communication strategies by the physicians.


CONCLUSIONS
The perspective of the physicians was mainly on prevention while the women were more focused on symptom alleviation. Each physician had a strategy of his/her own for the risk discussion. Thus, the major differences found between the consultations were between physicians, and not between the women. Risk discussion seemed to be aimed at motivating the woman to follow the physician's decision rather than to help her participate in the decision-making process.
Hoffmann
Mikael
M
Department of Medicine and Care, Division of Clinical Pharmacology, Linköping University, SE-581 85 Linköping, Sweden. mikael.hoffmann@lio.se
Lindh-Astrand
Lotta
L
Ahlner
Johan
J
Hammar
Mats
M
Kjellgren
Karin I
KI
D000328:Adult; D000554:Ambulatory Care Facilities; D003142:Communication; D015914:Estrogen Replacement Therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D018570:Risk Assessment; D013548:Sweden