Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Chris Gastmans, KU Leuven
- Second opponent: Dr. Anette Fosse, Øvermo legesenter
- Third member and chair of the evaluation committee: Adjunct Professor, Director Arild Bjørndal, University of Oslo
Chair of the Defence
Professor Emeritus Per Hjortdahl, University of Oslo
Principal Supervisor
Professor Reidar Pedersen, University of Oslo
Summary
Advance care planning assists people to share their personal values, life goals, and preferences for future medical care before it is too late. When in need of end-of-life decisions in nursing homes, the patient is often no longer capable of participating in any meaningful communication. Thus, advance care planning is essential to secure patient participation in the decision-making processes at the end of their life. One aim of this project was to improve patient participation in the decision-making processes at end of life in nursing homes.
The mixed methods research design included chart reviews, qualitative interviews, and observation of advance care planning. We did a cluster-randomized trial in eight nursing home wards. Advance care planning was the clinical intervention and we used a whole-ward approach in implementing it. Included in the whole-ward approach was involving patients as much as possible, also those with cognitive impairment, and involving next-of-kin as support for the patients.
We found improved nursing home patient participation in advance care planning, patients with cognitive impairment participated actively and relayed relevant information, and participants and observations found conversations as patient-focused. Cognitive impairment represented a challenge and indicate that advance care planning may profit from commencing before nursing home admission. However, the patients received support from their next-of-kin, which enabled them to participate in the discussions. This thesis indicates that advance care planning may lay an important foundation for person-centered care and for respecting patient autonomy, which extends to the nursing home context.
Additional information
Contact the research support staff.