CLINICAL DECISION-MAKING IN THE FACE OF SCIENTIFIC UNCERTAINTY - HORMONE REPLACEMENT THERAPY AS AN EXAMPLE

There is widespread variation in the prescribing patterns of postmenop ausal hormone replacement therapy. While some degree of variation is e xpected, the systematic variation according to geographic region, phys ician gender, and medical specialty raises questions about how clinica l decisions are made. This paper explores the determinants of these pr actice patterns, specifically the contribution of patients' preference s, scientific uncertainty, and physicians' recommendations. A role for col laborative decision-making is described and the use of decision-s upport tools is discussed. The primary care setting is proposed as the ideal context in which to study collaborative decision-malting. Addit ional research is needed to more fully elucidate the value of collabor ative decision-making with respect to clinical and quality of-life out comes, patient satisfaction with decision making, and costs.