Advanced Care Planning for the Severely Ill Home-dwelling Elderly

This study will develop and evaluate a complex intervention to implement guidelines for Advance care planning for severely ill home-dwelling elderly admitted to hospital, by using a cluster randomized design.Twelve Norwegian hospital units will participate in the study, each as one cluster. Of the twelve clusters, half will receive implementation support and training immediately, and the other half will receive similar support after the intervention period. The study includes a) assessment of service level outcomes, including the perspectives of health personnel, by measuring fidelity scores, by questionnaires to health personnel and before and after the implementation period and by qualitative interviews with health personnel; b) assessment of selected outcomes for patients and relatives, by collecting questionnaires and data from central health registers and patient records and by qualitative interviews with patients and relatives, and c) a cost-effectiveness analysis and d) a political economy analysis.

Inclusion criteria for patients:HomedwellingConsent to participate both from the patient and one close relative70 year or older at the time of inclusionAcutely admitted to geriatric units or a medical units with a geriatric doctorClinical frailty score of 5 or moreEligible and willing to participate in ACP if offeredHealth personnel answers "no" to "Surprise question" from Gold Standards Framework proactive identification guidanceExclusion criteria for patients:Participated in Advance care planning earlierNot being competent to consent to participation in researchPatients who are expected to die within 24 hoursNot having any relatives or next of kinInadequate Norwegian skillsInclusion criteria for relatives:Being a close relative of a patient who consents to participate18 years or older at the time of inclusionProvides consent to participateExclusion criteria for relatives:Not being competent to consent to participation in researchInadequate Norwegian skills