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Abstract：
Close to half of all deaths in Norway occur in nursing homes, which signals a need for good communication on end-of-life care. Advance care planning (ACP) is one means to that end, but in Norwegian nursing homes, ACP is not common. This paper describes the protocol of a project evaluating an ACP-intervention in Norwegian nursing homes. The aims of this research project were to promote the possibility for conversations about the end of life with patients and relatives; promote patient autonomy; create a better foundation for important decisions in the case of medical emergencies and at the end of life; and gain experiences in order to find out what characterizes good ACP and good implementation strategies.
This study was a mixed method study including a cluster-randomized clinical trial. Eight nursing home wards or \"clusters\" were pair-matched, and one ward from each pair was randomly selected for a 12-month intervention. The intervention consisted of implementing an ACP-guideline. Implementation strategies were training and supervision of project teams and staff in using the guideline, written information to patients and next of kin, and information meetings with nursing home staff. The project was evaluated using both quantitative and qualitative data, and both outcome and process evaluation. Quantitative data included patient chart reviews of ACP, diagnoses, patient preferences for decision-making and treatment, values and wishes that are more general, documented life-prolonging treatment and hospitalizations, and concordance between patient wishes and treatment. The primary outcome was documented ACP. Qualitative data included observations of conversations, interviews with patients, next of kin and health care personnel, logs from project coordinators and conversations, and transcripts from meetings with project teams in the intervention group.
This project attempted to increase the quality and use of ACP in Norwegian nursing homes (NH). A mixed methods approach, inclusion of patients with dementia, attempts to involve, as many patients as possible, and a sustainable implementation plan adapted to real life in nursing homes were strengths of the project.
This study was a mixed method study including a cluster-randomized clinical trial. Eight nursing home wards or \"clusters\" were pair-matched, and one ward from each pair was randomly selected for a 12-month intervention. The intervention consisted of implementing an ACP-guideline. Implementation strategies were training and supervision of project teams and staff in using the guideline, written information to patients and next of kin, and information meetings with nursing home staff. The project was evaluated using both quantitative and qualitative data, and both outcome and process evaluation. Quantitative data included patient chart reviews of ACP, diagnoses, patient preferences for decision-making and treatment, values and wishes that are more general, documented life-prolonging treatment and hospitalizations, and concordance between patient wishes and treatment. The primary outcome was documented ACP. Qualitative data included observations of conversations, interviews with patients, next of kin and health care personnel, logs from project coordinators and conversations, and transcripts from meetings with project teams in the intervention group.
This project attempted to increase the quality and use of ACP in Norwegian nursing homes (NH). A mixed methods approach, inclusion of patients with dementia, attempts to involve, as many patients as possible, and a sustainable implementation plan adapted to real life in nursing homes were strengths of the project.
摘要：
挪威近一半的死亡发生在疗养院，这表明需要在临终关怀方面进行良好的沟通。提前护理计划(ACP)是实现这一目标的一种手段，但是在挪威的疗养院，ACP并不常见。本文介绍了一项评估挪威养老院ACP干预措施的项目方案。该研究项目的目的是促进与患者和亲属进行生命终结对话的可能性；促进患者自主性；在医疗紧急情况和生命终结时为重要决策创造更好的基础；并获得经验，以找出良好的ACP和良好的实施策略的特征。
本研究为混合方法研究，包括整群随机临床试验。八个疗养院病房或“集群”配对，从每一对病房中随机选择一个病房进行为期12个月的干预。干预措施包括实施ACP指南。实施策略是对项目团队和员工使用指南的培训和监督，给患者和近亲的书面信息，以及与疗养院工作人员的信息会议。使用定量和定性数据对项目进行了评估，以及结果和过程评估。定量数据包括ACP的患者图表回顾，诊断,患者对决策和治疗的偏好，更普遍的价值观和愿望，有记录的延长生命的治疗和住院，以及患者意愿和治疗之间的一致性。主要结果是记录的ACP。定性数据包括对对话的观察，采访患者,亲属和医护人员的近亲，来自项目协调员和对话的日志，以及与干预小组项目团队的会议记录。
该项目试图提高ACP在挪威养老院（NH）的质量和使用。混合方法方法，纳入痴呆症患者，试图参与，尽可能多的病人，适合养老院实际生活的可持续实施计划是该项目的优势。
本研究为混合方法研究，包括整群随机临床试验。八个疗养院病房或“集群”配对，从每一对病房中随机选择一个病房进行为期12个月的干预。干预措施包括实施ACP指南。实施策略是对项目团队和员工使用指南的培训和监督，给患者和近亲的书面信息，以及与疗养院工作人员的信息会议。使用定量和定性数据对项目进行了评估，以及结果和过程评估。定量数据包括ACP的患者图表回顾，诊断,患者对决策和治疗的偏好，更普遍的价值观和愿望，有记录的延长生命的治疗和住院，以及患者意愿和治疗之间的一致性。主要结果是记录的ACP。定性数据包括对对话的观察，采访患者,亲属和医护人员的近亲，来自项目协调员和对话的日志，以及与干预小组项目团队的会议记录。
该项目试图提高ACP在挪威养老院（NH）的质量和使用。混合方法方法，纳入痴呆症患者，试图参与，尽可能多的病人，适合养老院实际生活的可持续实施计划是该项目的优势。
