Objective. To describe patients' evaluation of the contents of preventive cardiovascular consultations and to analyse whether their evaluation is shaped by self-reported cognitive and emotional effects and lifestyle changes two to six weeks after the consultations. Design. Questionnaire developed by means of qualitative studies. Setting.Two counties in Denmark. Subjects. A total of 2450 subjects who had participated in a preventive cardiovascular consultation with their GP received a questionnaire; 1714 responded (70%); 1226 fulfilled the inclusion criteria, namely to be at increased risk of cardiovascular disease (CVD) but without having CVD. Main outcome measures. Cognitive and emotional effects and lifestyle changes. Odds ratios (ORs) were calculated between self-reported issues raised during the consultations and self-reported lifestyle changes, cognitive and emotional effects. Results. Some 58-79% reported cognitive effects (knowledge about risk and disease), 22-57% lifestyle changes (diet, exercise, and smoking), 80-97% emotional effects related to relief and satisfaction, and 23% worries. Those who reported that a dialogue had taken place (e.g. information concerning risk of disease, life habits, life circumstances/daily living, perception of risk, knowledge about disease, and own possibilities for prevention) had ORs between 1.7 and 4.3 for reporting three or more cognitive effects and one or more lifestyle changes (p 0.05). These issues were also significantly related to emotional effects such as feeling relieved and satisfied. Conclusion. Patients report cognitive and emotional effects and healthy lifestyle changes following a cardiovascular preventive consultation and the magnitude of the effect is associated with the nature of the issues raised.

To describe patients' evaluation of the contents of preventive cardiovascular consultations and to analyse whether their evaluation is shaped by self-reported cognitive and emotional effects and lifestyle changes two to six weeks after the consultations.Questionnaire developed by means of qualitative studies.Two counties in Denmark.A total of 2450 subjects who had participated in a preventive cardiovascular consultation with their GP received a questionnaire; 1714 responded (70%); 1226 fulfilled the inclusion criteria, namely to be at increased risk of cardiovascular disease (CVD) but without having CVD.Cognitive and emotional effects and lifestyle changes. Odds ratios (ORs) were calculated between self-reported issues raised during the consultations and self-reported lifestyle changes, cognitive and emotional effects.Some 58-79% reported cognitive effects (knowledge about risk and disease), 22-57% lifestyle changes (diet, exercise, and smoking), 80-97% emotional effects related to relief and satisfaction, and 23% worries. Those who reported that a dialogue had taken place (e.g. information concerning risk of disease, life habits, life circumstances/daily living, perception of risk, knowledge about disease, and own possibilities for prevention) had ORs between 1.7 and 4.3 for reporting three or more cognitive effects and one or more lifestyle changes (p < 0.05). These issues were also significantly related to emotional effects such as feeling relieved and satisfied.Patients report cognitive and emotional effects and healthy lifestyle changes following a cardiovascular preventive consultation and the magnitude of the effect is associated with the nature of the issues raised.

BACKGROUND:The development of consultations towards more patient centredness and shared decision making has greatly influenced general practice. Several patient-based studies have been published on shared decision making in screening and health checks. However, few studies have explored the process in-depth to understand perspectives of patients at high cardiovascular risk and their experiences of preventive consultations.AIM:To explore and analyse experiences of preventive consultations in patients at high cardiovascular risk.METHOD:Individual, semi-structured interviews with 12 patients at increased risk of cardiovascular disease (CVD) conducted within two weeks of a dedicated preventive consultation. Grounded theory was used in the analysis.RESULTS:The patients' experienced benefits from the consultation included changed emotions, thoughts, readiness to change lifestyle and perceived knowledge related to health and risk. Patients reported that their experienced benefits were related to the general practitioner's (GP's) professional competence, communication in the consultation and especially the doctor-patient relationship. Patients also expressed a number of unfulfilled expectations concerning their opportunities to contribute their personal perspectives to the consultation, short consultation duration, problems with appropriate timing and personal relevance of content and insufficient tailoring to their personal situation. GPs' communication skills and scheduling of follow-up consultations were reported by the patients as essential for these specific aspects to be addressed successfully.CONCLUSION:Patients reported a number of benefits from preventive consultations. However, their unfulfilled expectations suggest the benefits could be even greater, both with enhanced communication skills from doctors, and attention to appropriate timing of the consultations at stages of life when patients are more able to make changes.

BACKGROUND:Motivational interviewing approaches are currently recommended in primary prevention and treatment of cardiovascular disease (CVD) in general practice in Denmark, based on an empirical and multidisciplinary body of scientific knowledge about the importance of motivation for successful lifestyle change among patients at risk of lifestyle related diseases. This study aimed to explore and describe motivational aspects related to potential lifestyle changes among patients at increased risk of CVD following preventive consultations in general practice.METHODS:Individual interviews with 12 patients at increased risk of CVD within 2 weeks after the consultation. Grounded theory was used in the analysis.RESULTS:Ambivalence related to potential lifestyle changes was the core motivational aspect in the interviews, even though the patients rarely verbalised this experience during the consultations. The patients experienced ambivalence in the form of conflicting feelings about lifestyle change. Analysis showed that these feelings interacted with their reflections in a concurrent process. Analysis generated a typology of five different ambivalence sub-types: perception, demand, information, priority and treatment ambivalence.CONCLUSION:Ambivalence was a common experience in relation to motivation among patients at increased risk of CVD. Five different ambivalence sub-types were found, which clinicians may use to explore and resolve ambivalence in trying to aid patients to adopt lifestyle changes. Future research is needed to explore whether motivational interviewing and other cognitive approaches can be enhanced by exploring ambivalence in more depth, to ensure that lifestyle changes are made and sustained. Further studies with a wider range of patient characteristics are required to investigate the generalisability of the results.