• Trygve J L Sævareid, Lisbeth Thoresen, Elisabeth Gjerberg, Lillian Lillemoen, and Reidar Pedersen.
• Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway. Electronic address: t.j.l.savareid@medisin.uio.no.
• Patient Educ Couns. 2019 Dec 1; 102 (12): 2183-2191.

ObjectiveTo improve patient participation in advance care planning in nursing homes where most patients have some degree of cognitive impairment.MethodsThis was a pair-matched cluster randomized clinical trial with eight wards in eight Norwegian nursing homes. We randomized one ward from each of the matched pairs to the intervention group. We included all patients above 70. The primary outcome was prevalence of documented patient participation in end-of-life treatment conversations. The intervention included implementation support using a whole-ward approach where regular staff perform advance care planning and invite all patients and next of kin to participate.ResultsIn intervention group wards the patients participated more often in end-of-life treatment conversations (p < 0.001). Moreover, the patient's preferences, hopes AND worries (p = 0,006) were more often documented, and concordance between provided TREATMENT and patient preferences (p = 0,037) and next of kin participation in advance care planning with the patient (p = 0,056) increased.ConclusionImproved patient participation - also when cognitively impaired - is achievable through advance care planning in nursing homes using a whole-ward approach.Practice ImplicationsPatients with cognitive impairment should be included in advance care planning supported by next of kin. A whole-ward approach may be used to implement advance care planning.Trial RegistrationISRCTN registry (ID ISRCTN69571462) - retrospectively registered.Copyright © 2019 Elsevier B.V. All rights reserved.

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