title: Risk communication in consultations about hormone therapy in the menopause: concordance in risk assessment and framing due to the context.
abstract: BACKGROUND
  It is important for the physician and the patient to have a mutual understanding of the possible consequences of different treatment alternatives in order to achieve a partnership in decision-making.
  
  
  OBJECTIVE
  The aim of this study was to explore to which degree first-time consultations for discussion of climacteric discomfort achieved shared understanding of the risks and benefits associated with hormone therapy in the menopausal transition.
  
  
  METHODS
  Analysis of structure and content of transcribed consultations (n = 20), and follow-up interviews of the women (n = 19 pairs of consultations and interviews), from first-time visits for discussion of climacteric discomfort and/or HT with five physicians at three different outpatient clinics of gynecology in Sweden.
  
  
  RESULTS
  Four distinctively different interpretations of risk, depending on whether or not benefits were discussed in the same context, emerged from the analysis. On average, five advantages (range 0-11) and two (0-3) disadvantages were mentioned during the consultations. In the interviews, the women expressed on average four advantages (0-7) and one disadvantage (0-3). There were major variations between advantages and disadvantages expressed in the consultation and the following interview.
  
  
  CONCLUSIONS
  Even though the consultations scored high in patient involvement, the information in most consultations was not structured in a way that made it possible to achieve a shared or an informed decision-taking.
authors.affiliation: Department of Medicine and Care, Division of Clinical Pharmacology, Faculty of Health Sciences, Linköpings Universitet, Linköping, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Hoffmann
authors.forename: M
authors.initials: M
authors.lastname: Hammar
authors.forename: K I
authors.initials: KI
authors.lastname: Kjellgren
authors.forename: L
authors.initials: L
authors.lastname: Lindh-Astrand
authors.forename: J
authors.initials: J
authors.lastname: Ahlner
mesh_terms: D003142:Communication; D003657:Decision Making; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008593:Menopause; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D018570:Risk Assessment; D013548:Sweden