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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Implementing Advance Care Planning - A Cluster Randomised Controlled Study

Alternative title: Implementering av forhåndssamtaler

Awarded: NOK 12.0 mill.

Elderly patients and their relatives are often inadequately involved in discussions about their treatment and care. Advance care planning (ACP) is a very promising way to explore the patient's values and preferences, and to tailor future health care and decision-making processes to the patient?s wishes. ACP can contribute to more efficient, patient-centred and integrated care, improve satisfaction, and reduce distress and overtreatment. Despite strong evidence of the benefits and emphasis in national policies, implementation of ACP is still patchy. This project aims to improve health services, user involvement and quality of life for severely ill elderly people living at home, and their relatives, in an efficient, sustainable and coordinated way, through better implementation of ACP. We will: 1. Map the current level of implementation of ACP for severely ill elderly patients in selected hospital wards and community services. 2. Identify the most important barriers and facilitators to implementing ACP, including moral dilemmas and conflicting interests. 3. Develop and use innovative implementation support. 4. Investigate whether the implementation support improves ACP implementation, and whether better implementation of ACP improves outcomes for patients, family, and services. 5. Measure the cost-effectiveness of the ACP and the implementation support. The project aligns with HELSEVEL?s priorities to improve quality, competence, efficiency and collaboration within and across health services and academia. We will also bridge the gap between evidence and practice. The implementation support includes innovative training and handling of barriers, builds upon real-life evidence and stakeholder input. Our approach combines responsive and participatory action research with an RCT-design. Stakeholder involvement, collaborative effort, and potential benefits for all users and for cost reductions are extensive. Preliminary results indicates that advance care planning is to a little extent implementeted systematically in the examined hospital wards and primary health care services.

Elderly patients and their relatives are often inadequately involved in discussions about their treatment and care. Advance care planning (ACP) is a very promising way to explore the patient's values and preferences, and to tailor future health care and decision-making processes to the patient’s wishes. ACP can contribute to more efficient, patient-centred and integrated care, improve satisfaction, and reduce distress and overtreatment. Despite strong evidence of the benefits and emphasis in national policies, implementation of ACP is still patchy. This project aims to improve health services, user involvement and quality of life for severely ill elderly people living at home, and their relatives, in an efficient, sustainable and coordinated way, through better implementation of ACP. We will: 1. Map the current level of implementation of ACP for severely ill elderly patients in selected hospital wards and community services 2. Identify the most important barriers and facilitators to implementing ACP on the clinical organisational and policy level, including moral dilemmas and conflicting interests 3. Develop and use innovative implementation support 4. Investigate whether the implementation support improves ACP implementation, and whether better implementation of ACP improves outcomes for patients, family, and services 5. Measure the cost-effectiveness of the ACP and the implementation support The project aligns with HELSEVEL’s priorities to improve quality, competence, efficiency and collaboration within and across health services and academia. We will also bridge the gap between evidence and practice. The implementation support includes innovative training and handling of barriers, builds upon real-life evidence and stakeholder input. Our approach combines responsive and participatory action research with an RCT-design. Stakeholder involvement, collaborative effort, and potential benefits for all users and for cost reductions are extensive.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester