Patients' understanding of risk: A qualitative study of decision-making about the menopause and hormone replacement therapy in general practice

Abstract

Objective. To explore women's understanding of the risks associated with the menopause and hormone replacement therapy (HRT). Methods. Two general practices in Cambridge participated in this qualitative study using focus groups and semi-structured interviews. Forty women aged between 50 and 55 years, known to be current users, ex-users, or never-users of HRT were included in the study. Results. Participants viewed risk as a danger: coping with risk required an assessment to facilitate an informed decision. To understand risk and make a personal interpretation, patients used their own knowledge, the presentation and context of that risk, together with their individual belief system particularly relating to representations of womanhood, lay beliefs and fatalism, control and choice. Experience, age and emotions often modified the salience of risk, and participants then used this meaning to weigh up the risks and benefits of a particular threat. Conclusion. Participants gained understanding of risk by an active risk assessment process involving individual and complex interplay between knowledge and core beliefs, allowing the assessment of risks and benefits to facilitate an informed decision about the menopause and HRT.