Shared decision-making in the context of menopausal health: Where do we stand?

Most health decisions occur in contexts of scientific uncertainty, the “grey zone” of decision-making and many decisions faced by menopausal women are no exception. These contexts are characterized either by scientific evidence that points to a balance between harms and benefits within or between options, or by the absence or insufficiency of scientific evidence: both situations give rise to degrees of uncertainty. Moreover, probabilities of risks and benefits in a population cannot be directly attributed at the individual level, and so uncertainty inevitably exists when considering individual decisions. Consequently, both clinicians and menopausal women need help in resolving uncertainty when facing clinical decisions. In other words, we argue that the ideal model for making decisions in the context of scientific uncertainty is the sharing of decisions between a clinician and a patient, a process known as shared decision-making (SDM). The objectives of this paper are to: (1) review the theoretical basis underlying effective interventions for SDM to occur in the context of menopausal health; (2) present the evidence regarding existing decision support interventions for menopausal women; and (3) identify implications for clinicians, health professional educators and researchers.