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Risk communication in consultations about hormone therapy in the menopause – concordance in risk assessment and framing due to the context
Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Department of Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden.
2006 (English)In: Climacteric, ISSN 1369-7137, Vol. 9, no 5, 347-354 p.Article in journal (Refereed) Published
Abstract [en]


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.


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 (HT).


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 out-patient clinics of gynaecology in Sweden.


Four distinctively different interpretations of risk, depending on whether or not benefits were discussed in the same context, emerged from the analysis. On average 5 advantages (range 0-11) and 2 (0-3) disadvantages were mentioned during the consultations. In the interviews the women expressed on average 4 advantages (0-7) and 1 disadvantage (0-3). There were major variations between advantages and disadvantages expressed in the consultation and the following interview.


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 making.

Place, publisher, year, edition, pages
2006. Vol. 9, no 5, 347-354 p.
Keyword [en]
Risk, Risk assessment, Communication, Physician-Patient Relations, Professional-Patient Relations
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-11692DOI: 10.1080/13697130600870220OAI: diva2:18117
Original publication: Hoffmann M, Hammar M, Kjellgren K I, Lindh-Åstrand L and Ahlner J, Risk communication in consultations about hormone therapy in the menopause – concordance in risk assessment and framing due to the context, 2006, Climacteric, (9), 5, 347-354. Copyright © Taylor & Francis Group, an informa businessAvailable from: 2008-10-13 Created: 2008-10-13 Last updated: 2009-05-19Bibliographically approved
In thesis
1. Risk Talk: On Communicating Benefits and Harms in Health Care
Open this publication in new window or tab >>Risk Talk: On Communicating Benefits and Harms in Health Care
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

One of the most critical elements in empowering the patient, and ensuring concordance, is communication of the possible benefits and harms of different actions in health care. Risk assessment is a complex task due both to the different interpretations of the concept of risk, and the common lack of hard facts. Hormone, or hormone replacement, therapy (HT) is used by many women in, and after, the menopause. The benefits and possible harms associated with short and long term treatment with HT have been extensively discussed the last decade and the use of HT has decreased dramatically internationally the last few years.

The aims of this thesis were to study the interaction between patient and physician when discussing risks and benefits of different treatment alternatives, and to suggest strategies to improve risk communication in clinical practice. The studies have focused on how risks and benefits with HT were communicated between women and physicians during firsttime consultations in 1999- 2000 on this subject (20 women, 5 gynaecologists), and through questionnaires how attitudes towards HT have changed between 1999 (n=1,760) and 2003 (n=1,733) among women entering the menopause (53-54 years).

Through a qualitative analysis of the risk communication in the consultations a system was constructed to classify how risk is communicated in relation to benefits. This was used to assess and present differences in risk communication in the consultations. Different rhetorical strategies by the physicians were identified and the dominating tendency was a move from the woman’s current problems to the long-term effects of HT.

The questionnaires showed a marked difference in attitudes towards HT between the years. In 2003 women perceived HT to be associated with higher risk and less benefits than in 1999. This correlated to a drastic reduction in the use of HT over the same period. Media was the most frequent source of information about HT during the last twelve months before the questionnaire in 2003.

Possible explanations for the different attitudes towards HT between women entering the menopause and gynaecologist; how this difference might have influenced the results; and how they may have implications for future communication strategies are discussed. This thesis illustrates the importance of a deeper understanding in health care of the concept of risk in order to achieve an adequate communication of risk. This is important both in consultations and in campaigns to educate and inform the public.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2006
Linköping University Medical Dissertations, ISSN 0345-0082 ; 933
risk, communication, menopause, hormone replacement therapy, physician-patient relations
National Category
Pharmacology and Toxicology
urn:nbn:se:liu:diva-7338 (URN)91-85497-68-1 (ISBN)
Public defence
2006-01-26, Berzeliussalen,, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Reprinted figure 1 on page 32 with permission from Science Ref # 05-17260-Revised. Copyright 2006 AAAS.Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2009-08-22

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