Physicians' Understandings and Experience of Advance Care Planning in Norwegian Nursing Homes: a Qualitative Study

Overview

Journal BMC Palliat Care

Publisher Biomed Central

Specialty Critical Care

Date 2024 Jun 24

PMID 38915021

Authors

Liv Odbehr

Reidun Hov

Harald Sanaker

Asa Serholt Jensen

Aina Korup

Tuva Sandsdalen

Affiliations

Soon will be listed here.

Abstract

Background: Advance care planning is a way of facilitating conversations with patients about future health care, values, and preferences at end of life. Nursing home physicians have the medical responsibility and the main obligation to facilitate planned meetings with patients. Although there has been a great deal of focus on establishing advance care planning in Norwegian nursing homes, it has yet to be widely implemented. Stated reasons are that the work routines in a nursing home do not include such meetings or that implementation seems complex due to frail patients. The aim of this study is thus to explore how physicians understand and experience advance care planning and follow-up of care plans in Norwegian nursing homes.

Methods: The study has a qualitative research design with a phenomenological-hermeneutic approach based on interviews of twelve nursing home physicians working in community care. Interviews were conducted in February 2023 to May 2023, using a semi-structured interview guide. All interviews were recorded on audio files, transcribed, and analyzed using structural text analysis.

Results: The findings are presented based on the following themes: (1) advance care planning is a dialog and a process, (2) advance care planning implies clarifying mutual expectations, and (3) advance care planning that brings relief and hope to patients is a medical art.

Conclusions: Advance care planning is a complex and dynamic process that implies medical treatment, decisions on treatment level, pain relief, and formulation of care plans where the patient's self-determination and personal values are respected. It implies an ongoing dialogue between physicians, patients, and their relatives about values such as dignity, self-understanding, social relations, and existential questions at end of life. Advance care planning requires a holistic approach that meets patients' psychological and existential needs such as comfort, trust, hope, and respect as well as their preferences and concerns.

Citing Articles

Physicians' Perceptions of the Quality of Palliative Care and of the Importance of Collaboration in Interdisciplinary Teams in Norwegian Nursing Homes.

Odbehr L, Hov R, Sanaker H, Sandsdalen T J Multidiscip Healthc. 2025; 18:395-406.

PMID: 39881823 PMC: 11776417. DOI: 10.2147/JMDH.S487153.

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