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Hormone replacement therapy in the menopause - structure and content of risk talk
Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
National Board of Forensic Medicine, Linköping, Sweden.
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
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2005 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 50, no 1, 8-18 p.Article in journal (Refereed) Published
Abstract [en]

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.

Design: 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.

Place, publisher, year, edition, pages
2005. Vol. 50, no 1, 8-18 p.
Keyword [en]
Hormone replacement therapy, Risk, Communication, Patient participation, Patient compliance, Concordance
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13970DOI: 10.1016/j.maturitas.2004.03.014OAI: diva2:22353
Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2013-12-16Bibliographically 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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