Forberedende samtaler i norske sykehjem

Gjerberg, Elisabeth; Lillemoen, Lillian; Weaver, Kristin; Pedersen, Reidar; Før­de, Rei­dun

doi:10.4045/tidsskr.16.0284

Cited by 18 publications

(12 citation statements)

References 25 publications

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“…Regarding ACP conversations, our findings show that individual preferences vary greatly with respect to the style of approach, explicit mention of death or dying, involvement of family members, and the type of supports required. This is consistent with other studies [ 47 , 52 ] that have reported highly personalized ACP preferences, and highlights the need for an approach that is tailored to each individual patient. This also points to the value of having ACP led by someone who is familiar with the patient and has established a rapport with them.…”

Section: Discussionsupporting

confidence: 91%

Patient and caregiver perspectives on early identification for advance care planning in primary healthcare settings

et al. 2020

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Background: As part of a broader study to improve the capacity for advance care planning (ACP) in primary healthcare settings, the research team set out to develop and validate a computerized algorithm to help primary care physicians identify individuals at risk of death, and also carried out focus groups and interviews with relevant stakeholder groups. Interviews with patients and family caregivers were carried out in parallel to algorithm development and validation to examine (1) views on early identification of individuals at risk of deteriorating health or dying; (2) views on the use of a computerized algorithm for early identification; and (3) preferences and challenges for ACP. Methods: Fourteen participants were recruited from two Canadian provinces. Participants included individuals aged 65 and older with declining health and self-identified caregivers of individuals aged 65 and older with declining health. Semi-structured interviews were conducted via telephone. A qualitative descriptive analytic approach was employed, which focused on summarizing and describing the informational contents of the data. Results: Participants supported the early identification of patients at risk of deteriorating health or dying. Early identification was viewed as conducive to planning not only for death, but for the remainder of life. Participants were also supportive of the use of a computerized algorithm to assist with early identification, although limitations were recognized. While participants felt that having family physicians assume responsibility for early identification and ACP was appropriate, questions arose around feasibility, including whether family physicians have sufficient time for ACP. Preferences related to the content of and approach to ACP discussions were highly individualized. Required supports during ACP include informational and emotional supports. Conclusions: This work supports the role of primary care providers in the early identification of individuals at risk of deteriorating health or death and the process of ACP. To improve ACP capacity in primary healthcare settings, compensation systems for primary care providers should be adjusted to ensure appropriate compensation and to accommodate longer ACP appointments. Additional resources and more established links to community organizations and services will also be required to facilitate referrals to relevant community services as part of the ACP process.

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Section: Discussionsupporting

confidence: 91%

Patient and caregiver perspectives on early identification for advance care planning in primary healthcare settings

et al. 2020

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“…This study has a comprehensive size and a variety of units, which promote generalizability. In addition, the present study provides detailed descriptions of the implementation process, the definition of successful implementation and information on the involvement of staff, which facilitates replicability and meaningful comparisons with future studies as well as the adaptability of the knowledge to the clinical field [ 9 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Description of an advance care planning intervention in nursing homes: outcomes of the process evaluation

2018

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BackgroundAdvance Care Planning (ACP) is the repeated communication and decision-making process between the patient, family, and healthcare professionals. This study describes an ACP intervention in nursing homes and evaluates the outcomes of the implementation process.MethodsThe ACP intervention was part of a 4-month complex, cluster randomized controlled trial (COSMOS). 37 Norwegian nursing homes with 72 units (1 cluster = 1 unit) and 765 patients were invited to participate and eligible units were randomised to the intervention group or control. Nursing home staff in the intervention group was offered a standardized education programme to learn early and repeated communication with patients and families and to implement ACP in their units. We used a train-the-trainer approach to educate staff in the units, supported by regular telephone calls and a midway seminar after two months. Individual patient logs consisting of different communication deliverables were used to evaluate the implementation process. Supported by Qualitative Content Analyses, we identified facilitators and barriers of the ACP implementation based on feedback during midway seminars and individual patient logs.ResultsThe ACP intervention was conducted in 36 NH units (n = 297); 105 healthcare providers participated at the education seminar prior to the study, and 3–4 employees from each unit participated in the midway seminar. NH staff reported the educational material relevant for the implementation strategy. The patient logs showed that ACP was successfully implemented in 62% (n = 183) of the patients using our predefined implementation criteria. The staff emphasized the clear communication of the relevance of ACP addressed to leaders and staff as important facilitators, along with the clearly defined routines, roles and responsibilities. Identified barriers included lack of competence, perceived lack of time, and conflicting culture and staff opinions.ConclusionMonthly communication with the family was the most frequently conducted communication, and the predefined criteria of successfully implemented ACP were largely achieved. Nursing home routines and engagement of leaders and staff were crucial facilitators, whereas lack of time and competence reduced the implementation success.Trial registrationThe COSMOS-trial was registered in the ClinicalTrials.gov (NCT02238652) July 7th, 2014Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0713-7) contains supplementary material, which is available to authorized users.

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“…National guidelines in Norway strongly recommend that severely ill patients are given opportunities to express their values and preferences through ACP 15. However, we know that ACP in nursing homes, which is the place of death for half the Norwegian population,16 is scarce 17. In addition, health care personnel report a lack of routines for ACP in nursing homes18 and are in need of more competence in discussing death and dying 19…”

Section: Introductionmentioning

confidence: 99%

<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

Sævareid¹,

Førde²,

Thoresen³

et al. 2019

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Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance. Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP. Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources. Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.

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Forberedende samtaler i norske sykehjem

Cited by 18 publications

References 25 publications

Patient and caregiver perspectives on early identification for advance care planning in primary healthcare settings

Patient and caregiver perspectives on early identification for advance care planning in primary healthcare settings

Description of an advance care planning intervention in nursing homes: outcomes of the process evaluation

<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

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