title: Ethical issues in cardiovascular risk management: Patients need nurses' support.
abstract: Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of patients with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle.
authors.affiliation: Maastricht University, The Netherlands.
authors.forename: Marije S Koelewijn-van
authors.initials: MS
authors.lastname: Loon
authors.affiliation: Maastricht University, The Netherlands anneke.vandijk@maastrichtuniversity.nl.
authors.forename: Anneke
authors.initials: A
authors.lastname: van Dijk-de Vries
authors.affiliation: Maastricht University, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: Cardiff University, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.affiliation: VU University Medical Center, The Netherlands.
authors.forename: Guy Am
authors.initials: GA
authors.lastname: Widdershoven
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D009426:Netherlands; D024802:Nurse's Role; D009723:Nurse-Patient Relations / Q000941:ethics*; D011322:Primary Prevention / Q000941:ethics*; D012307:Risk Factors; D012308:Risk Management / Q000941:ethics* / Q000379:methods
keywords: Cardiovascular diseases; ethics; motivational interviewing; nurse-led care; primary prevention; qualitative research; shared decision-making