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Risk talk: rhetorical strategies in consultations on hormone replacement therap
Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Culture and Communication. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
2005 (English)In: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 5, no 2, 139-154 p.Article in journal (Refereed) Published
Abstract [en]

When analysing risk discussions in medical settings it is important to consider the specific activity type. In this qualitative study 20 first-time consultations by healthy women regarding hormone replacement therapy (HRT) in the menopause the risk discussion is asymmetrical with the doctors dominating. Despite being set up as a specific opportunity for women in the menopause to discuss problems and risks, it comes forth as a decision-making activity in a traditional medical setting. The consultations fulfil to a high extent the demands for informed decision making, but the risk discussions are recontextualised into a cost-benefit discourse with a typical implicit quantitative bias. The doctors use several different rhetorical strategies such as positive introduction of HRT, embedding drawbacks in positive introductions and/or exits thereby diminishing them. The word risk is avoided to a considerable extent and the term 'drawbacks' is used instead. The most obvious strategy is to move from the woman's symptoms to aspects of prevention, thus changing the discussion from the menopause and different strategies to cope with menopausal problems into a medically oriented discussion of pharmacological treatment alternatives. The 'change of life' in these talks is entirely conceptualised within a 'medical model'.

Place, publisher, year, edition, pages
Hants, UK: Carfax Publishing, 2005. Vol. 5, no 2, 139-154 p.
Keyword [en]
Risk, Communication, Menopause, Hormone Replacement Therapy, Physician-patient Relations
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13972DOI: 10.1080/1369857031000123920ISI: 000184127500003OAI: diva2:22355
Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2013-12-04
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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Hoffmann, MikaelLinell, PerLindh-Åstrand, LottaKjellgren, Karin I.
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