Reidun Førde

• Jorem, Jacob; Førde, Reidun; Husum, Tonje Lossius; Dahlberg, Jørgen & Pedersen, Reidar (2025). Assessing decision-making capacity in clinical practice in Norway: a qualitative exploration of stakeholder perspectives. BMC Psychiatry. 25. doi: 10.1186/s12888-025-07161-z. Full text in Research Archive Show summary

  Decision-making capacity (DMC) is a widely used criterion in health law, but assessments pose challenges in practice. In Norway, lacking DMC became an additional criterion for involuntary care and treatment following comprehensive amendments to the Mental Health Care Act in 2017. Contrary to the amendments’ objectives, involuntary care rates have continued to increase after an initial reduction in 2017. Assessing DMC typically involves four abilities: understanding, reasoning, appreciating relevant information, and communicating a choice. This four abilities model was introduced to aid in DMC assessments. With limited assessment experience pre-2017, the Norwegian context offers valuable insights into how stakeholders integrate DMC into clinical practice over time. This study aimed to explore how DMC was assessed in clinical practice following the introduction of a capacity-based mental health law governing involuntary care and treatment in Norway. In 2018, semi-structured interviews and focus groups were conducted with 44 key stakeholders, including psychiatrists, specialists in clinical psychology, general practitioners, and lawyers in supervisory bodies (the Control Commission and County Governor). In 2022–23, 21 of these participants took part in individual follow-up interviews. The interviews were transcribed and thematically analysed. Data analysis generated three themes with subthemes: (1) DMC assessments primarily relied on the four abilities model in specialist care, experiencing gradual clinical adaptation with decreased importance, and exhibited variations in quality, particularly in primary care; (2) several challenges in DMC assessments, including lack of training in applying the four abilities model, ownership, continuity of care, information, and patient cooperation, with certain patient groups posing particular challenges, such as those with manic symptoms, substance misuse, and severe eating disorders; and (3) quality assurance measures needed, including systematic training and tools to improve assessment quality. Assessing DMC involves variations and several challenges across the healthcare system. While the four abilities model served as a primary basis of DMC assessments in specialist care, systematic training, validated tools, and further research seem needed to improve assessment quality and better understand factors influencing assessments. Recognising the complex interplay between legal, health service, and societal factors when implementing health law reforms seems crucial for achieving their objectives.

• Jorem, Jacob; Førde, Reidun; Husum, Tonje Lossius; Dahlberg, Jørgen & Pedersen, Reidar (2025). Factors influencing decision-making capacity assessments in involuntary care and treatment in Norway: A qualitative exploration of multi-stakeholder perspectives. International Journal of Law and Psychiatry. ISSN 0160-2527. 104. doi: 10.1016/j.ijlp.2025.102157. Full text in Research Archive Show summary

  Background Decision-making capacity (DMC) is a widely used criterion in health laws to balance respect for patient autonomy with protection from the potential consequences of treatment decisions. In 2017, lacking DMC was introduced as an additional criterion for involuntary care and treatment following comprehensive amendments to the Norwegian Mental Health Care Act. Despite the amendments aiming to reduce involuntary care and treatment rates, national health registry data indicate continued rising rates along the pre-2017 trajectory after an initial reduction in 2017. While previous studies suggesting varying DMC assessment quality, little is known about the potential factors influencing these variations. Aims To identify factors influencing DMC assessments after introducing a capacity-based mental health law governing involuntary care and treatment. Methods 60 purposively sampled stakeholders, including patients, families, health professionals, and lawyers, participated in semi-structured interviews and focus groups in 2018, with 26 of these participating in follow-up interviews in 2022–23. The transcribed interviews were analysed using thematic analysis. Results Data analysis generated four themes: 1) available resources' influence on DMC assessments; 2) health professionals' values and practices regarding involuntary care; 3) legal interpretations by supervisory bodies regarding involuntary care; and 4) political signals from the health authorities regarding involuntary care. Conclusion DMC assessments appear to be influenced by several factors, including resource availability, health professionals' values and practices, legal interpretations by supervisory bodies, and political signals from health authorities. Combined with a lack of systematic training and validated tools, these factors may have raised the threshold for accessing mental healthcare beyond what systematic DMC assessments would suggest, contributing to increased illness severity among patients and rising involuntary care rates post-2017. Further research is needed to better understand the complex dynamics involved in DMC assessments and how to effectively implement capacity-based health laws.

• Hov, Laila; Førde, Reidun; Steindal, Simen Alexander; Myrhaug, Hilde Tinderholt; Skogestad, Ingrid Johansen & Juel, Bjørn Erik (2025). Perspectives, attitudes and experiences of introducing noninvasive medical technologies in end-of-life care: a scoping review. BMC Palliative Care. 24(1), p. 1–7. doi: 10.1186/s12904-025-01890-4. Full text in Research Archive Show summary

  Abstract Background There is a strong tradition for withdrawing medical equipment from patients receiving end-of-life (EOL) care. However, the introduction of new noninvasive medical equipment could be acceptable provided that it improves the quality of care and patient comfort. Objectives We aimed to systematically map published studies of the perspectives, attitudes and experiences of health care professionals, dying patients, and their next of kin, about introducing noninvasive medical technology in end-of-life care. Design We conducted a scoping review. On January 27, 2025, systematic searches of five databases were carried out (Medline (EBSCO), CINAHL, Embase, Academic Search Elite, and Cochrane Library CDSR). Inclusion criteria were empirical studies published in English or Scandinavian languages. We searched for qualitative, quantitative or mixed method studies focusing on perspectives on, experiences of and attitudes toward introducing noninvasive medical technologies in end-of-life care from the view of health care professionals, dying patients, and their next of kin. Three pairs of researchers independently assessed potential eligibility and data extraction. Data would be summarized qualitatively. Results The searches yielded 3288 unique articles, 3194 of which were excluded following an initial screening. Among the remaining 94 articles, none satisfied our inclusion criteria. Thus, we found no empirical articles addressing perspectives on, attitudes toward, or experiences with the use of noninvasive medical technology in end-of-life care. Conclusions Empirical research exploring the perspectives on, attitudes toward, and experiences of, and use of noninvasive medical technology in end-of-life care is needed. This is important for understanding when and how it is feasible, useful, and ethical to introduce such technologies in the terminal phase of palliative care.

• Jorem, Jacob; Førde, Reidun; Husum, Tonje Lossius; Dahlberg, Jørgen & Pedersen, Reidar (2025). Impact of introducing a capacity-based mental health law in Norway: Qualitative exploration of multi-stakeholder perspectives. BJPsych Open. 11(2). doi: 10.1192/bjo.2024.810. Full text in Research Archive Show summary

  Background Decision-making capacity (DMC) is key to capacity-based mental health laws. In 2017, Norway introduced a lack of DMC as an additional criterion for involuntary care and treatment to strengthen patient autonomy and reduce involuntary care. Health registry data reveal an initial reduction followed by rising involuntary care and treatment rates post-2017. Despite jurisdictions moving towards capacity-based mental health laws, little is known about their impact. Aims To explore the impact of introducing a capacity-based mental health law governing involuntary care and treatment. Method Semi-structured interviews and focus groups were conducted in 2018 with 60 purposively sampled stakeholders, including patients, families, health professionals and lawyers. Of these, 26 participated in individual follow-up interviews in 2022–23. The transcribed interviews were thematically analysed following Braun and Clarke. Results Four themes emerged: (a) increased awareness of patient autonomy and improved patient involvement; (b) altered thresholds for involuntary admission and discharge and more challenging to help certain patient groups; (c) more responsibility for primary health services; and (d) increased family responsibility but unchanged involvement by health services. Conclusions Introducing a capacity-based mental health law appears to raise awareness of patient autonomy, but its impact depends on an interplay of complex health, social and legal systems. Post-2017 changes, including rising involuntary care and treatment rates, higher thresholds for admissions and increased pressure on primary health services and families, may be influenced by several factors. These include implementation of decision-making capacity, legal interpretations, formal measures for care of non-resistant incompetent individuals, reduced in-patient bed availability, inadequate voluntary treatment options and societal developments. Further research is needed to better understand these changes and their causes.

• Larsen, Berit Hofset; Gerwing, Jennifer; Lundeby, Tonje; Gulbrandsen, Pål & Førde, Reidun (2025). More than an extra set of ears: A video-based analysis exploring the role of companions in routine oncology visits. Journal of psychosocial oncology. ISSN 0734-7332. 43(5), p. 682–703. doi: 10.1080/07347332.2025.2457964. Full text in Research Archive Show summary

  Purpose Patients with advanced cancer commonly bring a companion to medical appointments, often a family member. Despite increasing focus on family involvement, few studies are based on observations of real-life consultations. This study aimed to explore how companions contribute to the information exchange process during advanced cancer outpatient visits. Methods Data were ten videos of routine oncology visits. We identified when and how companions participated using microanalysis of clinical interaction. Findings Companion participation varied greatly. They tended to speak up spontaneously, contributing medical, personal, and contextual information that might otherwise have remained unsaid. They both brought information into the discussion and facilitated information exchanged between the physician and patient. Companions displayed few of their own concerns. Conclusions The findings suggest that companions may be an important resource during oncology visits, not only for the patient, but also for healthcare providers aiming for person-centered care to the individual patient.

• Brøderud, Linn; Førde, Reidun; Romøren, Maria; Wahl, Astrid Klopstad & Pedersen, Reidar (2025). Barriers and Facilitators to the Implementation of Advance Care Planning: A Qualitative Study at National and Organizational Levels. Journal of Evaluation In Clinical Practice. ISSN 1356-1294. 31(4). doi: 10.1111/jep.70131. Full text in Research Archive Show summary

  Background Aging population, enhanced medical opportunities, increased costs and emphasis on patient participation make advance care planning (ACP) important and it provides an evidence-based framework to ensure patient autonomy in future healthcare decisions. Despite the extensive international research literature supporting ACP, implementation seems challenging. Implementing complex interventions like ACP probably requires a system-wide approach. However, there is scarce research on the barriers and facilitators to ACP implementation as perceived at national and organizational levels. Aim To explore the barriers and facilitators affecting ACP implementation as perceived at national and organizational levels. Methods Fifteen in-depth individual interviews were conducted with stakeholders at national and organizational levels. A semi-structured interview guide was used, targeting overarching conditions and framework factors that could have an impact. Data was analysed using thematic analysis. Results Barriers to ACP implementation described by participants included: Lack of prioritization of ACP at all levels; paradigms and culture of healthcare delivery, personal barriers and attitudes, and lack of competence; lack of collaboration and documentation between levels of healthcare; and lack of systems, routines, time and resources within healthcare services. Facilitators included: Cultural change; support in priority setting; national guideline and incentives; management commitment and support; systems, routines and local implementation efforts; ACP capacity building, implementation competence, and ethical reflection; dissemination of the benefits of ACP, including public education; and better collaboration and communication between levels of healthcare. Conclusion There appear to be significant barriers and facilitators to ACP implementation as perceived at the national and organizational levels of healthcare. Although ACP implementation appears to require a combination of top-down and bottom-up initiatives, national and organizational barriers and facilitators seem important in setting priorities in clinical practice, with an emphasis on financial incentives. An overarching cultural change of healthcare delivery that supports interventions such as ACP appears to be critical for improved implementation.

• Romøren, Maria; Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita; Westbye, Siri Færden & Wahl, Astrid Klopstad [Show all 10 contributors for this article] (2024). Implementation of advance care planning in the routine care for acutely admitted patients in geriatric units: protocol for a cluster randomized controlled trial. BMC Health Services Research. 24. doi: 10.1186/s12913-024-10666-0. Full text in Research Archive Show summary

  Background Acutely ill and frail older adults and their next of kin are often poorly involved in treatment and care decisions. This may lead to either over- or undertreatment and unnecessary burdens. The aim of this project is to improve user involvement and health services for frail older adults living at home, and their relatives, by implementing advance care planning (ACP) in selected hospital wards, and to evaluate the clinical and the implementation interventions. Methods This is a cluster randomized trial with 12 hospital units. The intervention arm receives implementation support for 18 months; control units receive the same support afterwards. The ACP intervention consists of 1. Clinical intervention: ACP; 2. Implementation interventions: Implementation team, ACP coordinator, network meetings, training and supervision for health care personnel, documentation tools and other resources, and fidelity measurements with tailored feedback; 3. Implementation strategies: leadership commitment, whole ward approach and responsive evaluation. Fidelity will be measured three times in the intervention arm and twice in the control arm. Here, the primary outcome is the difference in fidelity changes between the arms. We will also include 420 geriatric patients with one close relative and an attending clinician in a triadic sub-study. Here, the primary outcomes are quality of communication and decision-making when approaching the end of life as perceived by patients and next of kin, and congruence between the patient’s preferences for information and involvement and the clinician’s perceptions of the same. For patients we will also collect clinical data and health register data. Additionally, all clinical staff in both arms will be invited to answer a questionnaire before and during the implementation period. To explore barriers and facilitators and further explore the significance of ACP, qualitative interviews will be performed in the intervention units with patients, next of kin, health care personnel and implementation teams, and with other stakeholders up to national level. Lastly, we will evaluate resource utilization, costs and health outcomes in a cost-effectiveness analysis. Discussion The project may contribute to improved implementation of ACP as well as valuable knowledge and methodological developments in the scientific fields of ACP, health service research and implementation science.

• Schaufel, Margrethe Aase; Førde, Reidun; Sigurdardottir, Katrin Rut & Miljeteig, Ingrid (2024). Lungelegar sine erfaringar med lindrande sedering i livets sluttfase. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(13), p. 1–12. doi: 10.4045/tidsskr.23.0778. Full text in Research Archive Show summary

  Bakgrunn Legeforeningen har utarbeidd retningslinjer for lindrande sedering i livets sluttfase, sist revidert i 2014. Vi ville undersøke lungelegar sin kjennskap til retningslinjene og bruk av lindrande sedering ved lungesjukdomar. Materiale og metode Eit elektronisk spørjeskjema blei sendt til alle medlemmer av Norsk forening for lungemedisin (529 legar) i oktober 2022. Svara blei analysert med deskriptiv statistikk, og fritekstkommentarane blei analysert ved systematisk tekstkondensering. Resultat Totalt 50 legar svarte (9,5 %). 22 hadde kjennskap til retningslinjene, og eit mindretal meinte desse var tydelege og gav god støtte. 37 oppgav at lindrande sedering blei gjennomført der dei jobba, men det var stor variasjon i kor ofte. 25 av deltakarane hadde vore med på å gjennomføre lindrande sedering ein eller fleire gonger, og 19 hadde opplevd etiske utfordringar relatert til dette. Sederinga vart oftast utført hjå pasientar med lungekreft ved intraktabel dyspné og smerter, men også hjå andre sjukdomsgrupper. Avgjerda vart stort sett tatt i tverrfagleg fellesskap, og fritekstkommentarane utdjupa at dette gav støtte og tryggleik. Det vart påpeikt ein krevjande grenseoppgang mot dødshjelp, og ønskje om at gråsonene kunne utdjupast meir i retningslinjene. Tolking Definisjonen av lindrande sedering blir framleis oppfatta ulikt og kan framstå uklar. Det kan moglegvis vere til hjelp å legge til diagnosespesifikke råd ved revisjon av gjeldande retningslinjer.

• Miljeteig, Ingrid; Førde, Reidun; Rø, Karin Elisabet Isaksson; Bååthe, Fredrik & Bringedal, Berit (2024). Moral distress among physicians in Norway: a longitudinal study. BMJ Open. 14(5). doi: 10.1136/bmjopen-2023-080380. Full text in Research Archive Show summary

  Objectives To explore and compare physicians’ reported moral distress in 2004 and 2021 and identify factors that could be related to these responses. Design Longitudinal survey. Setting Data were gathered from the Norwegian Physician Panel Study, a representative sample of Norwegian physicians, conducted in 2004 and 2021. Participants 1499 physicians in 2004 and 2316 physicians in 2021. Main outcome measures The same survey instrument was used to measure change in moral distress from 2004 to 2021. Logistic regression analyses examined the role of gender, age and place of work. Results Response rates were 67% (1004/1499) in 2004 and 71% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased as 68.3% reported this ‘somewhat’ or ‘very morally distressing’ in 2004 compared with 75.1% in 2021. Moral distress also increased concerning that patients who ‘cry the loudest’ get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients and acting against one’s conscience. Women reported higher moral distress than men at both time points, and there were significant gender differences for six statements in 2021 and one in 2004. Age and workplace influenced reported moral distress, though not consistently for all statements. Conclusion In 2004 and 2021 physicians’ moral distress related to scarcity of time or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one’s conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.

• Molewijk, Albert Christiaan; Pedersen, Reidar; Kok, Almar; Førde, Reidun & Aasland, Olaf Gjerløw (2023). Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees’ normative attitudes, user involvement and the handling of disagreement. BMC Medical Ethics. 24. doi: 10.1186/s12910-023-00909-w. Full text in Research Archive Show summary

  Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices.

• Larsen, Berit Hofset; Lundeby, Tonje; Gulbrandsen, Pål; Førde, Reidun & Gerwing, Jennifer (2022). Physicians’ responses to advanced cancer patients’ existential concerns: A video-based analysis. Patient Education and Counseling. ISSN 0738-3991. 105(10), p. 3062–3070. doi: 10.1016/j.pec.2022.06.007. Full text in Research Archive Show summary

  Objective In a recent study, we explored what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation and how they communicate such concerns. The current study builds on these results, investigating how the physicians responded to those concerns. Methods We analyzed video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue. Results We identified 185 immediate physician-responses to the 127 patient existential utterances we had previously identified. The responses demonstrated three approaches: giving the patient control over the content, providing support, and taking control over the content. The latter was by far the most common, through which the physicians habitually kept the discussion around biomedical aspects and rarely pursued the patients’ existential concerns. Conclusions Although the physicians, to some extent, allowed the patients to talk freely about their concerns, they systematically failed to acknowledge and address the patients’ existential concerns. Practice implications Physicians should be attentive to their possible habit of steering the agenda towards biomedical topics, hence, avoiding patients’ existential concerns. Initiatives cultivating behavior enhancing person-centered and existential communication should be implemented in clinical practice and medical training.

• Robertsen, Annette; Helseth, Eirik & Førde, Reidun (2021). Inter-physician variability in strategies linked to treatment limitations after severe traumatic brain injury; proactivity or wait-and-see. BMC Medical Ethics. 22(1). doi: 10.1186/s12910-021-00612-8. Full text in Research Archive Show summary

  Background Prognostic uncertainty is a challenge for physicians in the neuro intensive care field. Questions about whether continued life-sustaining treatment is in a patient’s best interests arise in different phases after a severe traumatic brain injury. In-depth information about how physicians deal with ethical issues in different contexts is lacking. The purpose of this study was to seek insight into clinicians’ strategies concerning unresolved prognostic uncertainty and their ethical reasoning on the issue of limitation of life-sustaining treatment in patients with minimal or no signs of neurological improvement after severe traumatic brain injury in the later trauma hospital phase. Methods Interviews with 18 physicians working in a neurointensive care unit in a large Norwegian trauma hospital, followed by a qualitative thematic analysis focused on physicians’ strategies related to treatment-limiting decision-making. Results A divide between proactive and wait-and-see strategies emerged. Notwithstanding the hospital’s strong team culture, inter-physician variability with regard to ethical reasoning and preferred strategies was exposed. All the physicians emphasized the importance of team—family interactions. Nevertheless, their strategies differed: (1) The proactive physicians were open to consider limitations of life-sustaining treatment when the prognosis was grim. They initiated ethical discussions, took leadership in clarification and deliberation processes regarding goals and options, saw themselves as guides for the families and believed in the necessity to prepare families for both best-case and worst-case scenarios. (2) The “wait-and-see” physicians preferred open-ended treatment (no limitations). Neurologically injured patients need time to uncover their true recovery potential, they argued. They often avoided talking to the family about dying or other worst-case scenarios during this phase. Conclusions Depending on the individual physician in charge, ethical issues may rest unresolved or not addressed in the later trauma hospital phase. Nevertheless, team collaboration serves to mitigate inter-physician variability. There are problems and pitfalls to be aware of related to both proactive and wait-and-see approaches. The timing of best-interest discussions and treatment-limiting decisions remain challenging after severe traumatic brain injury. Routines for timely and open discussions with families about the range of ethically reasonable options need to be strengthened.

• Heggestad, Anne Kari Tolo & Førde, Reidun (2021). Pårørendes roller i tildeling av langtidsplass i sykehjem. Sykepleien Forskning. ISSN 1890-2936. 16. doi: 10.4220/Sykepleienf.2021.83882. Full text in Research Archive Show summary

  Bakgrunn: Med et økende antall eldre følger et økende press på kommunale helse- og omsorgstjenester. Det betyr blant annet at det kan bli vanskeligere å få sykehjemsplass. For å sikre rettferdig tildeling er det av stor betydning å få kunnskap om hva som påvirker prioriteringene. Da må vi også vite hvilken rolle pårørende spiller i tildelingsprosessen. Hensikt: Hensikten med artikkelen var å undersøke pårørendes rolle i tildelingen av langtidsplass på sykehjem. Metode: Studien bygger på kvalitativ metode med en eksplorativ tilnærming. Vi inkluderte fire kommuner og gjennomførte 16 intervjuer med saksbehandlere på tildelingskontor samt sykepleiere og leger på korttidsavdelinger. Vi foretok også 13 observasjoner av møter mellom saksbehandlere og helsepersonell ved korttidsavdelingene. Vi gjorde en tematisk innholdsanalyse av intervjuer og feltnotater. Resultat: Deltakerne i studien opplevde at pårørende spiller en viktig rolle i tildelingsprosessen av kommunale helse- og omsorgstjenester. De kan bidra som en viktig omsorgsressurs og dermed også være en «buffer» i systemet. Samtidig er de ofte pådrivere i tildelingen av langtidsplass på sykehjem. Det kan true våre idealer om rettferdighet og likebehandling. Konklusjon: Det er viktig med åpne tildelingsprosesser og ekstra søkelys på pasienter uten sterke pårørende. Pårørende som stiller opp som buffere i helsetjenesten, trenger oppmerksomhet og avlastning. Det er behov for tydeligere retningslinjer for hva som skal være pårørendes ansvar, og hva som er det offentliges ansvar.

• Larsen, Berit Hofset; Lundeby, Tonje; Gerwing, Jennifer; Gulbrandsen, Pål & Førde, Reidun (2021). “Eh – What type of cells are these – flourishing in the liver?” Cancer patients’ disclosure of existential concerns in routine hospital consultations. Patient Education and Counseling. ISSN 0738-3991. doi: 10.1016/j.pec.2021.11.010. Full text in Research Archive Show summary

  Objective Advanced cancer poses a threat to all aspects of being, potentially causing existential suffering. We explore what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation, and how they communicate such concerns. Methods We analyzed thirteen video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue. Results Nearly all patients disclosed how the illness experience included losses and threats of loss that are strongly associated with existential suffering, displaying uncertainty about future and insecurity about self and coping. Patients usually disclosed existential concerns uninvited, but they did so indirectly and subtly, typically hiding concerns in biomedical terms or conveying them with hesitation and very little emotion. Conclusions Patients may have existential concerns they want to address, but they may be uncertain whether these are issues they can discuss with the physician. Practice implications Health professionals should be attentive to underlying existential messages embedded in the patient’s questions and concerns. Acknowledging these existential concerns provides an opportunity to briefly explore the patient’s needs and may direct how the physician tailors information and support to promote coping, autonomy, and existential health.

• Magelssen, Morten; Rasmussen, Magnhild; Wallace, Sean Ciaran & Førde, Reidun (2021). Priority setting at the clinical level: the case of nusinersen and the Norwegian national expert group. BMC Medical Ethics. 22(1), p. 1–8. doi: 10.1186/s12910-021-00623-5. Full text in Research Archive Show summary

  Background Nusinersen is one of an increasing number of new, expensive orphan drugs to receive authorization. These drugs strain public healthcare budgets and challenge principles for resource allocation. Nusinersen was introduced in the Norwegian public healthcare system in 2018. A national expert group consisting of physicians was formed to oversee the introduction and continuation of treatment in light of specific start and stop criteria. Methods We have studied experiences within the expert group with a special emphasis on their application of the start and stop criteria, rationing of treatment, and experienced moral dilemmas. A research interview with six members of the national expert group was performed, then analysed with manifest content analysis. The analysis was supplemented with publically available sources on priority setting and the process leading up to the introduction of nusinersen and the establishment of the expert group. Results Sixty-six patients have received treatment within the first 25 months since the national expert group’s establishment. Treatment has not been discontinued for any patient. No patients under 18 years of age have been denied treatment, as those who were referred at this age were all deemed to fulfill the start criteria. The expert group has, however, increased geographical treatment equity and facilitated important cooperation at the national level. Furthermore, it has enhanced open and critical discussions of both medical issues and new ethical dilemmas. Conclusion Although facilitating equal access to treatment for SMA patients, the national expert group has not discontinued treatment for any patient. It is suggested that in order for clinicians to be able to ration care for individual patients, they require both adequate support and sufficient formal authority. Start and stop criteria need to be re-evaluated as more knowledge and experience are gained regarding the treatment.

• Litleskar, Liv Astrid; Strander, Mette Tolås; Førde, Reidun & Magelssen, Morten (2020). Refusals to perform ritual circumcision: a qualitative study of doctors’ professional and ethical reasoning. BMC Medical Ethics. 21. doi: 10.1186/s12910-020-0444-0. Full text in Research Archive Show summary

  Background Ritual circumcision of infant boys is controversial in Norway, as in many other countries. The procedure became a part of Norwegian public health services in 2015. A new law opened for conscientious objection to the procedure. We have studied physicians’ refusals to perform ritual circumcision as an issue of professional ethics. Method Qualitative interview study with 10 urologists who refused to perform ritual circumcision from six Norwegian public hospitals. Interviews were recorded and transcribed, then analysed with systematic text condensation, a qualitative analysis framework. Results The physicians are unanimous in grounding their opposition to the procedure in professional standards and norms, based on fundamental tenets of professional ethics. While there is homogeneity in the group when it comes to this reasoning, there are significant variations as to how deeply the matter touches the urologists on a personal level. About half of them connect their stance to their personal integrity, and state that performing the procedure would go against their conscience and lead to pangs of conscience. Conclusions It is argued that professional moral norms sometimes might become more or less ‘integrated’ in the professional’s core moral values and moral identity. If this is the case, then the distinction between conscience-based and professional refusals to certain healthcare services cannot be drawn as sharply as it has been.

• Heggestad, Anne Kari Tolo; Førde, Reidun; Magelssen, Morten & Arnekleiv, Birgit (2020). Ethics reflection groups for school nurses. Nursing Ethics. ISSN 0969-7330. p. 1–11. doi: 10.1177/0969733020940373. Full text in Research Archive
• Dahlberg, Jørgen; Dahl, Vegard; Førde, Reidun & Pedersen, Reidar (2019). Lack of informed consent for surgical procedures by elderly patients with inability to consent: a retrospective chart review from an academic medical center in Norway. Patient Safety in Surgery. 13(24). doi: 10.1186/s13037-019-0205-5. Full text in Research Archive Show summary

  Background Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing. Method We investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion. Results None of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare. Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion. Discussion and conclusion We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.

• Thoresen, Lisbeth; Pedersen, Reidar; Lillemoen, Lillian; Gjerberg, Elisabeth & Førde, Reidun (2019). Advance care planning in Norwegian nursing homes – limited awareness of the residents’ preferences and values? A qualitative study. BMC Geriatrics. 19(1), p. 1–6. doi: 10.1186/s12877-019-1378-6. Full text in Research Archive Show summary

  Background 52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals’ views on ACP is vital. The objective of this study is to explore nurses and physicians’ aims and experiences with carrying out ACP in nursing homes. Methods Semi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data. Results The primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear. Conclusion Our study add insights into how ACP is practiced in nursing homes and the professionals’ agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents’ needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.

• Sævareid, Trygve Johannes Lereim; Førde, Reidun; Thoresen, Lisbeth; Lillemoen, Lillian & Pedersen, Reidar (2019). Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers. Clinical Interventions in Aging. ISSN 1176-9092. 14, p. 997–1005. doi: 10.2147/CIA.S203298. Full text in Research Archive Show summary

  Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance. Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP. Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources. Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.

• Robertsen, Annette; Helseth, Eirik; Laake, Jon Henrik & Førde, Reidun (2019). Neurocritical care physicians' doubt about whether to withdraw life-sustaining treatment the first days after devastating brain injury: An interview study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27:81, p. 1–8. doi: 10.1186/s13049-019-0648-9. Full text in Research Archive Show summary

  Background Multilevel uncertainty exists in the treatment of devastating brain injury and variation in end-of-life decision-making is a concern. Cognitive and emotional doubt linked to making challenging decisions have not received much attention. The aim of this study was to explore physicians´ doubt related to decisions to withhold or withdraw life-sustaining treatment within the first 72 h after devastating brain injury and to identify the strategies used to address doubt. Method Semi-structured interviews were conducted with 18 neurocritical care physicians in a Norwegian trauma centre (neurosurgeons, intensivists and rehabilitation specialists) followed by a qualitative thematic analysis. Result All physicians described feelings of doubt. The degree of doubt and how they dealt with it varied. Institutional culture, ethics climate and individual physicians´ values, experiences and emotions seemed to impact judgements and decisions. Common strategies applied by physicians across specialities when dealing with uncertainty and doubt were: 1. Provision of treatment trials 2. Using time as a coping strategy 3. Collegial counselling and interdisciplinary consensus seeking 4. Framing decisions as purely medical. Conclusion Decisions regarding life-sustaining treatment after devastating brain injury are crafted in a stepwise manner. Feelings of doubt are frequent and seem to be linked to the recognition of fallibility. Doubt can be seen as positive and can foster open-mindedness towards the view of others, which is one of the prerequisites for a good ethical climate. Doubt in this context tends to be mitigated by open interdisciplinary discussions acknowledging doubt as rational and a normal feature of complex decision-making.

• Magelssen, Morten; Pedersen, Reidar; Miljeteig, Ingrid; Ervik, Håvard & Førde, Reidun (2019). Importance of systematic deliberation and stakeholder presence: A national study of clinical ethics committees. Journal of Medical Ethics. ISSN 0306-6800. 46(2), p. 66–70. doi: 10.1136/medethics-2018-105190. Full text in Research Archive Show summary

  Background: Case consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation. Methods: Prospective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated. Results: Evaluations of 64 case consultations were received. Cases were complex with multiple ethical problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method. Conclusions: CEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule.

• Heggestad, Anne Kari Tolo & Førde, Reidun (2019). Is allocation of nursing home placement in Norway just? Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.12792. Full text in Research Archive Show summary

  Background One of the core ethical principles in the Norwegian welfare state is the principle of justice; all citizens should have equal access to healthcare services, including nursing homes, independent of where they live, socioeconomic status or age. Patients who apply for a permanent place in a nursing home are among society’s most vulnerable. Hence, it is of great importance that the process of nursing home placement is just. The purpose of this study was to explore which criteria and values allocation of nursing home placements are built on, and whether the process is just. Methods The study has a qualitative design. Data were collected through individual interviews and observation. Executive officers in different municipalities who have the formal responsibility for the placements, and GPs and nurses on short‐term wards in nursing homes were interviewed. In addition, one of the researchers observed meetings where allocation of municipal healthcare services was discussed. Results Healthcare personnel in primary health care mainly agree on which criteria are the most important in order to safeguard the principle of justice. However, some unintended and less highlighted factors could jeopardise the ideal of fair and just allocation. Some of these were organizational variations, variations in the municipalities’ economy, variations in individual judgments and resourceful and strong‐willed relatives. Conclusions Our study indicates that some of the weakest and most vulnerable patients in the Norwegian society are not treated equally. In order to safeguard the principle of justice, specific national criteria should be used in allocation of nursing home placements. However, national criteria are not enough. We suggest that in addition to guiding criteria, the unintended factors should be given more attention and focus on how to control them in a better way.

• Skårdal, Ingvild Haraldstad & Førde, Reidun (2018). Vedtak om å avstå fra gjenoppliving i sykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(5). doi: 10.4045/tidsskr.17.0133. Full text in Research Archive
• Magelssen, Morten & Førde, Reidun (2018). Prioritering i helsetjenesten: Ni dilemmaer i kjølvannet av Spinraza-saken. Nytt Norsk Tidsskrift (NNT). ISSN 0800-336X. doi: 10.18261/issn.1504-3053-2018-03-04-08. Full text in Research Archive Show summary

  I februar 2018 ble det vedtatt å innføre behandling med det kostbare legemiddelet nusinersen (Spinraza) for den sjeldne genetiske sykdommen spinal muskelatrofi i den offentlige helsetjenesten. Avgjørelsen kom etter en langvarig prosess og stor medieoppmerksomhet. «Spinraza-saken» aktualiserer mange utfordringer i arbeidet med å fremme gode prioriteringer i norsk helsetjeneste. Vi identifiserer og drøfter ni slike utfordringer.

• Hansen, Thor Willy Ruud & Førde, Reidun (2018). 37 saker om barn og ungdom diskutert i en klinisk etikk-komité. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(20), p. 1–6. doi: 10.4045/tidsskr.18.0085. Full text in Research Archive
• Hansen, Thor Willy Ruud; Aasland, Olaf Gjerløw; Janvier, Annie & Førde, Reidun (2018). Physician characteristics influence the trends in resuscitation decisions at different ages. Acta Paediatrica. ISSN 0803-5253. 107(12), p. 2115–2119. doi: 10.1111/apa.14326. Full text in Research Archive Show summary

  Aim: We examined how physicians in different medical specialties would evaluate treatment decisions for vulnerable patients in need of resuscitation. Methods: A survey depicting six acutely ill patients from newborn infant to aged, all in need of resuscitation with similar prognoses, was distributed (in 2009) to a representative sample of 1650 members of the Norwegian Medical Association and 676 members of the Norwegian Pediatric Association. Results: There were 1335 respondents (57% participation rate). The majority of respondents across all specialties thought resuscitation was in the best interest of a 24 weeks’ gestation preterm infant and would resuscitate the patient, but would also accept palliative care on the family's demand. Accepting a family's refusal of resuscitation was more common for the newborn infants. Specialists were overall similar in their answers, but specialty, age and gender were associated with different answers for the patients at both ends of the age spectrum. Conclusion: Resuscitation decisions for the very young do not always seem to follow the best interest principle. Specialty and personal characteristics still have an impact on how we consider important ethical issues. We must be cognisant of our own valuations and how they may influence care.

• Aasland, Olaf Gjerløw; Pedersen, Reidar; Førde, Reidun & Husum, Tonje Lossius (2018). Samtykke og tvang. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Full text in Research Archive
• Sævareid, Trygve Johannes Lereim; Lillemoen, Lillian; Thoresen, Lisbeth; Førde, Reidun; Gjerberg, Elisabeth & Pedersen, Reidar (2018). Implementing advance care planning in nursing homes - study protocol of a cluster-randomized clinical trial. BMC Geriatrics. 18(1). doi: 10.1186/s12877-018-0869-1. Full text in Research Archive Show summary

  Background 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. Methods/design 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. Discussion 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.

• Magelssen, Morten; Pedersen, Reidar & Førde, Reidun (2018). Hvordan arbeider klinisk etikk-komiteene? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(2), p. 134–137. doi: 10.4045/tidsskr.17.0375. Full text in Research Archive
• Aasland, Olaf Gjerløw; Husum, Tonje Lossius; Førde, Reidun & Pedersen, Reidar (2018). Between authoritarian and dialogical approaches: Attitudes and opinions on coercion among professionals in mental health and addiction care in Norway. International Journal of Law and Psychiatry. ISSN 0160-2527. 57, p. 106–112. doi: 10.1016/j.ijlp.2018.02.005. Full text in Research Archive Show summary

  More knowledge is needed on how to reduce the prevalence of formal and informal coercion in Norwegian mental health care. To explore possible reasons for the widespread differences in coercive practice in psychiatry and drug addiction treatment in Norway, and the poor compliance to change initiatives, we performed a nationwide survey. Six vignettes from concrete and realistic clinical situations where coercive measures were among the alternative courses of action, and where the difference between authoritarian (paternalistic) and dialogical (user participation) practices was explicitly delineated, were presented in an electronic questionnaire distributed to five groups of professionals: psychiatrists, psychologists, nurses, other professionals and auxiliary treatment staff. Non-coercive dialogical resolutions were more likely than coercive authoritative. However, there is a clear professional hierarchy with regard to authoritarian approaches, with the psychiatrists on top, followed by nurses and other professionals, and with psychologists as the least authoritarian. The majority of the respondents sometimes prefer actions that are illegal, which suggests that individual opinions about coercion often overrule legislation. The variation between and within professional groups in attitudes and opinions on coercion is extensive, and may account for some of the hitherto meagre results of two ministerial action plans for coercion reduction.

• Klomstad, Kristin; Pedersen, Reidar; Førde, Reidun & Romøren, Maria (2018). Involvement in decisions about intravenous treatment for nursing home patients: Nursing homes versus hospital wards. BMC Medical Ethics. 19(34), p. 1–9. doi: 10.1186/s12910-018-0258-5. Full text in Research Archive Show summary

  Background Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Methods Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. Results The patients’ capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. Conclusions This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. Trial registration ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

• Magelssen, Morten; Holmøy, Trygve; Horn, Morten Andreas; Fondenes, Ove; Dybwik, Knut Gustav & Førde, Reidun (2018). Ethical challenges in tracheostomy-assisted ventilation in amyotrophic lateral sclerosis. Journal of Neurology. ISSN 0340-5354. 265(11), p. 2730–2736. doi: 10.1007/s00415-018-9054-x. Full text in Research Archive Show summary

  The special nature of amyotrophic lateral sclerosis (ALS) and tracheostomy with invasive ventilation (TIV) leads to challenges that can be difficult in two senses: not only to handle well, but also to discuss with patients and other involved stakeholders. Because of the delicate nature of interpersonal relations and communication in ALS, some of the downsides to TIV may almost take on a nature of taboo, making them difficult to raise for open discussion. Yet these ethical challenges are important to be aware of, not only for health professionals and managers but, arguably, also for patients and next of kin. They are important also for a wider professional and societal debate about whether and to whom TIV should be offered. In this paper we highlight and examine ethical challenges in TIV for ALS, with a special emphasis on those that are hard to discuss openly and that therefore might fail to be addressed. The analysis is structured by the four core principles of healthcare ethics: beneficence, nonmaleficence, respect for patient autonomy, and justice.

• Karlsen, Heidi Marie; Gjerberg, Elisabeth; Førde, Reidun; Magelssen, Morten; Pedersen, Reidar & Lillemoen, Lillian (2018). Etikkarbeid i kommunal helse- og omsorgstjeneste – evaluering av etikkrefleksjonens innhold og betydning. Nordisk sygeplejeforskning. ISSN 1892-2678. 8(1), p. 22–36. doi: 10.18261/issn.1892-2686-2018-01-03. Full text in Research Archive Show summary

  Bakgrunn: Ansatte i kommunal helse- og omsorgstjenestene står overfor mange etiske utfordringer i sin arbeidshverdag. Det nasjonale prosjektet «Samarbeid om etisk kompetanseheving (2007–2015)» i regi av KS, hadde som målsetting å styrke den etiske kompetansen i helse-, sosial- og omsorgstjenestene i kommunene. Etikkprosjektet ble avsluttet som prosjekt i 2015. I den forbindelse har Senter for Medisinsk Etikk (SME) gjennomført en evaluering. Målet med studien var å undersøke hvilke saker de ansatte drøftet i etikkrefleksjon, om etikksatsningen har hatt betydning for tjenestekvaliteten og arbeidsmiljøet, og eventuelt hva slags betydning, og i hvilken grad det hadde bidratt til økt etikk-kompetanse. Metode: Studien har et kvalitativt design, hvor fokusgruppeintervju med ansatte i direkte pasientrelatert arbeid er benyttet som metode. Studiens funn er basert på ti fokusgruppeintervjuer, med totalt 56 personer. Resultater: Ansatte i kommunal helse- og omsorgstjeneste erfarer å stå i komplekse utfordringer som fordrer faglig kompetanse, men også kompetanse i etikk og helsejuss. Det var stor variasjon mellom og innad i gruppene om hva man snakket om i refleksjonsgruppene, alt fra begreper og etiske prinsipper til mer konkrete problemstillinger fra egen praksis. Situasjoner som omhandlet ulike verdiavveininger synes å være særlig krevende, og utfordret dem på flere måter. De mest omtalte temaene var bruk av tvang, samhandling med pårørende og beslutninger om behandlingsintensitet. Konklusjon: Studien viser at ansatte i kommunal helse- og omsorgstjeneste opplever at etikksatsingen har vært et viktig bidrag til kvalitetsutvikling og kompetanseheving, for å håndtere etiske utfordringer på en bedre måte og ser ut til å ha stor betydning for yrkesutøvelsen og for arbeidsmiljøet.

• Karlsen, Heidi Marie; Lillemoen, Lillian; Magelssen, Morten; Førde, Reidun; Pedersen, Reidar & Gjerberg, Elisabeth (2018). How to succeed with ethics reflection groups in community healthcare? Professionals’ perceptions. Nursing Ethics. ISSN 0969-7330. 26(4), p. 1243–1255. doi: 10.1177/0969733017747957. Full text in Research Archive Show summary

  Background: Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection. Objectives: To examine what the staff experience as promoters or as barriers to successful ethics reflection. Research design: The study has a qualitative design, where 56 participants in municipal healthcare participated in 10 different focus-group interviews. Ethical considerations: The data collection was based on the participants’ informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data. Results: The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator’s role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection. Discussion: The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group. Conclusion: Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities’ instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups.

• Romøren, Maria; Pedersen, Reidar & Førde, Reidun (2017). Én pasient, to verdener – samhandling mellom sykehjemsleger og sykehusleger. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(3), p. 193–197. doi: 10.4045/tidsskr.16.0099. Full text in Research Archive
• Magelssen, Morten; Miljeteig, Ingrid; Pedersen, Reidar & Førde, Reidun (2017). Roles and responsibilities of clinical ethics committees in priority setting. BMC Medical Ethics. 18. doi: 10.1186/s12910-017-0226-5. Full text in Research Archive Show summary

  Background: Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees (CECs) be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Method: Descriptions of activities involving priority setting in annual reports from Norwegian CECs (2003-2015) were studied and categorized through qualitative content analysis. Results: Three hundred thirty-nine reports from 38 CECs were studied. We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. Discussion: In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs’ work further. Conclusions: The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests.

• Robertsen, Annette; Førde, Reidun; Skaga, Nils Oddvar & Helseth, Eirik (2017). Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 25(44), p. 1–9. doi: 10.1186/s13049-017-0385-x. Full text in Research Archive Show summary

  Background Treatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting. Methods A retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs. Results TLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59 cases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding of neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD was made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent (20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients. The median time from the decision to death was 2 days (range 1–652). TLDs were documented in 93% of in-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD group cases. Family interaction and multi-team discussions were documented in >88% of cases, but no advanced directives were found, and notifications of patients’ preferences were found in only 7% of cases. Discussion Clinicians should consider limiting treatment if continued treatment is not in the patients best interest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting. Conclusion TLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context need to be further explored.

• Førde, Reidun & Pedersen, Reidar (2017). Etiske dilemmaer knyttet til taushetsplikt. In Pedersen, Reidar & Nortvedt, Per (Ed.), Etikk i psykiske helsetjenester. Gyldendal Akademisk. ISSN 9788205481633. p. 257–270. Full text in Research Archive
• Førde, Reidun; Nortvedt, Per; Pedersen, Reidar & Hem, Marit Helene (2017). Skjønn, usikkerhet og ydmykhet i psykiske helsetjenester. In Pedersen, Reidar & Nortvedt, Per (Ed.), Etikk i psykiske helsetjenester. Gyldendal Akademisk. ISSN 9788205481633. p. 41–53. Full text in Research Archive
• Førde, Reidun; Hem, Marit Helene & Nortvedt, Per (2017). Etikk og prioritering i psykiske helsetjenester. In Pedersen, Reidar & Nortvedt, Per (Ed.), Etikk i psykiske helsetjenester. Gyldendal Akademisk. ISSN 9788205481633. p. 271–290. Full text in Research Archive
• Bringedal, Berit; Rø, Karin Isaksson; Magelssen, Morten; Førde, Reidun & Aasland, Olaf G. (2017). Between professional values, social regulations and patient preferences: medical doctors' perceptions of ethical dilemmas. Journal of Medical Ethics. ISSN 0306-6800. 44(4), p. 239–243. doi: 10.1136/medethics-2017-104408. Full text in Research Archive Show summary

  Background: We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods: The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded (78%). We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession, and a private individual. Results: 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions: Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less discussed dilemmas are characterized by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions.

• Førde, Reidun & Aasland, Olaf Gjerløw (2017). Is imperfection becoming easier to live with for doctors? Clinical Ethics. ISSN 1477-7509. 12(1), p. 31–36. doi: 10.1177/1477750916682618. Full text in Research Archive Show summary

  Objective Being involved in serious patient injury is devastating for most doctors. During the last two decades, several efforts have been launched to improve Norwegian doctors’ coping with adverse events and complaints. Methods The method involved survey to a representative sample of 1792 Norwegian doctors in 2012. The questions on adverse events and its effects were previously asked in 2000. Results Response rate was 71%. More doctors reported to have been involved in episodes with serious patient harm in 2012 (35%) than in 2000 (28%), and more of the episodes were reported as required by law. Doctors below age 50 report better support from colleagues, more collegial retrospective discussion on the event and less patient/family blame. In all, 27% of the doctors had been reported to the Norwegian Board of Health Supervision; 79% of these complaints were rejected; 73% of the doctors who had received a reaction from the health authorities found the reaction reasonable, but almost one out of five practiced more testing and referrals after a complaint and 25% claimed that the complaint had made them into a more fearful doctor. Conclusion Our results indicate that adverse events are being met more openly in 2012 than in 2000, and that coping with imperfection and patient complaints is less devastating for new generations of doctors.

• Førde, Reidun; Veirød, Unni; Stenehjem, Aud Eldrid & Dunlop, Oona Borghild (2017). Skal en pasient som ikke samarbeider miste retten til helsehjelp? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(14-15). doi: 10.4045/tidsskr.17.0038. Full text in Research Archive
• Gjerberg, Elisabeth; Lillemoen, Lillian; Weaver, Kristin; Pedersen, Reidar & Førde, Reidun (2017). Forberedende samtaler i norske sykehjem. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(6), p. 447–450. doi: 10.4045/tidsskr.16.0284. Full text in Research Archive Show summary

  BAKGRUNN Sykehjemspasienter er ofte skrøpelige og har flere kroniske lidelser. Økt risiko for kritiske hendelser, sykehusinnleggelser og død peker på behovet for samtaler med pasient og pårørende om tiden fremover, hvordan man skal bli enig om gode beslutninger og hva som skal skje hvis helsetilstanden forverres. Tidligere studier har vist at et mindretall av sykehjemmene praktiserer slike forberedende samtaler. MATERIALE OG METODE En spørreskjemaundersøkelse ble forsommeren 2014 sendt til alle sykehjem i Norge. Det ble spurt om forekomst av og innhold i forberedende samtaler. RESULTATER Det kom svar fra 57 % av sykehjemmene (486 sykehjem). Omtrent to tredeler rapporterte at de «alltid» eller «som oftest» gjennomførte forberedende samtale og omtrent en tredel av dem hadde skriftlige retningslinjer. Samtalene fant først og fremst sted når pasientens helsetilstand ble forverret, når pasienten gikk inn i siste livsfase eller i forbindelse med innkomstsamtalen. Sykehusinnleggelse, smertelindring og hjerte-lunge-redning (HLR) var de hyppigste temaene. Pårørende og sykehjemslege deltok som oftest i samtalene, pasientene deltok mer sjeldent. FORTOLKNING Det var store variasjoner mellom sykehjemmene når det gjaldt forberedende samtaler. Dette kan dels forstås på bakgrunn av mangel på nasjonale retningslinjer, dels at dette er en relativ ny diskusjon i Norge. At pasientene sjelden deltok i samtalene, har trolig sammenheng med at det hos disse er en høy andel med kognitiv svikt, at legedekningen er lav og at det er en mangelfull kultur for pasientmedvirkning.

• Ottersen, Trygve; Førde, Reidun; Kakad, Meetali; Kjellevold, Alice; Melberg, Hans Olav & Moen, Atle [Show all 8 contributors for this article] (2016). A new proposal for priority setting in Norway: Open and fair. Health Policy. ISSN 0168-8510. 120(3), p. 246–251. doi: 10.1016/j.healthpol.2016.01.012. Full text in Research Archive
• Romøren, Maria; Pedersen, Reidar & Førde, Reidun (2016). How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway. BMC Medical Ethics. 17(1). doi: 10.1186/s12910-016-0088-2. Full text in Research Archive Show summary

  Background Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors’ descriptions of how they include the patient and next of kin in end-of-life decisions. Methods We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation. Results The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient’s best interest. Conclusions Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient’s values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.

• Materstvedt, Lars Johan & Førde, Reidun (2016). 'Dødshjelp': definisjoner, kliniske skillelinjer, og utviklingen internasjonalt 2011-2016. Omsorg: Nordisk tidsskrift for Palliativ Medisin. ISSN 0800-7489. p. 9–13. Full text in Research Archive
• Førde, Reidun (2016). Pasientinformasjon i eit etisk perspektiv. In Førde, Reidun; Kjelland, Morten & Stridbeck, Ulf (Ed.), Cand.mag., cand.med., cand.jur., cand.alt Festskrift til Aslak Syse. Gyldendal Juridisk. ISSN 9788205493728. p. 129–140. Full text in Research Archive

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• Magelssen, Morten; Førde, Reidun; Lillemoen, Lillian & Pedersen, Reidar (2020). Etikk i helsetjenesten. Gyldendal Akademisk. ISBN 9788205534605. 249 p. Full text in Research Archive

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• Pedersen, Reidar & Førde, Reidun (2024). Bygger bro mellom etikk og medisin. [Journal]. Tidsskrift for Den norske legeforening (Tidsskriftet). doi: 10.4045/tidsskr.24.11.14. Full text in Research Archive
• Larsen, Berit Hofset; Lundeby, Tonje; Gerwing, Jennifer; Gulbrandsen, Pål & Førde, Reidun (2023). Alvorlig syke kreftpasienter kan kamuflere sine eksistensielle bekymringer. Sykepleien Forskning. ISSN 1890-2936. doi: 10.4220/Sykepleiens.2023.93333. Full text in Research Archive
• Rasmussen, Magnhild; Wallace, Sean Ciaran; Ørstavik, Kristin; Popperud, Trine Haug; Ramm-Pettersen, Anette & Førde, Reidun (2023). Start- og stoppkriterierforsvært dyre medisiner – spinal muskelatrofi som eksempel. 143(14). doi: 10.4045/tidsskr.23.0346. Full text in Research Archive
• Førde, Reidun; Eeg-Henriksen, Hanne; Larsen, Berit Hofset; Semb, Mona & Dunlop, Oona Borghild (2022). Pasienters medbestemmelse - hvor går grensen? 142(8). doi: 10.4045/tidsskr.21.0782. Full text in Research Archive
• Haave, Per; Oscar, Hoftvedt Bjørn & Førde, Reidun (2022). Legenes makt – pasientenes og pårørendes maktesløshet. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(6), p. 530–532. Full text in Research Archive
• Førde, Reidun; Pedersen, Reidar & Magelssen, Morten (2022). Etiske dilemmaer ved amyotrofisk lateral sklerose og respiratorbehandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(16), p. 1372–1373. doi: 10.4045/tidsskr.22.0503. Full text in Research Archive
• Førde, Reidun & Hofmann, Bjørn Morten (2021). Koronasertifikat på bekostning av dem som har lidd mest? Full text in Research Archive
• Førde, Reidun & Iden, Pål (2021). To år med en havarikommisjon i helsetjenesten. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(11), p. 1–3. doi: 10.4045/tidsskr.21.0233. Full text in Research Archive
• Førde, Reidun (2021). Etiske dilemma i livets siste fase. Om forhåndssamtale. Full text in Research Archive
• Hansen, Thor Willy Ruud & Førde, Reidun (2021). First judgement on clinical ethics committees? Archives of Disease in Childhood. ISSN 0003-9888. 106(9), p. 929–931. doi: 10.1136/archdischild-2021-321735. Full text in Research Archive
• Wester, Gry; Førde, Reidun; Holm, Søren; Norheim, Ole Frithjof & Solberg, Berge (2020). Hvem bør få koronavaksine først? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(1), p. 10–10. Full text in Research Archive
• Heggestad, Anne Kari Tolo; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Førde, Reidun & Hellesø, Ragnhild (2020). Ofrer vi de gamle? Full text in Research Archive
• Heggestad, Anne Kari Tolo; Førde, Reidun; Pedersen, Reidar & Magelssen, Morten (2020). Prioriteringsutfordringer i helse- og omsorgstjenesten i kommunene under covid-19-pandemien. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 6(1). doi: 10.18261/issn.2387-5984-2020-01-11ER. Full text in Research Archive
• Magelssen, Morten; Førde, Reidun; Lillemoen, Lillian & Pedersen, Reidar (2020). Forord. In Magelssen, Morten; Førde, Reidun; Lillemoen, Lillian & Pedersen, Reidar (Ed.), Etikk i helsetjenesten. Gyldendal Akademisk. ISSN 9788205534605. p. 5–7. Full text in Research Archive
• Miljeteig, Ingrid & Førde, Reidun (2020). Helseetikk i et flerkulturelt samfunn. In Magelssen, Morten; Førde, Reidun; Lillemoen, Lillian & Pedersen, Reidar (Ed.), Etikk i helsetjenesten. Gyldendal Akademisk. ISSN 9788205534605. p. 180–188. Full text in Research Archive
• Larsen, Berit Hofset; Magelssen, Morten; Dunlop, Oona; Pedersen, Reidar & Førde, Reidun (2020). Etiske dilemmaer i sykehusene under covid-19-pandemien. 140(18), p. 1–5. doi: 10.4045/tidsskr.20.0851. Full text in Research Archive
• Ramberg, Bjørn Torgrim; Halvorsen, Marit; Førde, Reidun; Ambur, Ole Herman & Borge, Anne Inger Helmen (2019). Medforfatterskap - et stridens eple. 11. doi: 10.4045/tidsskr.19.0145. Full text in Research Archive
• Heggestad, Anne Kari Tolo & Førde, Reidun (2019). Priority setting in primary health care – a qualitative study on allocation of nursing home placements. Full text in Research Archive
• Hofmann, Bjørn Morten; Magelssen, Morten & Førde, Reidun (2019). Ikke det offentliges ansvar. Full text in Research Archive
• Hofmann, Bjørn Morten; Førde, Reidun & Magelssen, Morten (2019). Nødvendig helsehjelp eller bemidledes bakvei inn i offentlig helsetjeneste? 139(14). doi: 10.4045/tidsskr.19.0353. Full text in Research Archive
• Førde, Reidun & Pedersen, Reidar (2019). Har vi lukket øynene for voldelige eldre? Full text in Research Archive
• Pedersen, Reidar; Aasland, Olaf Gjerløw; Husum, Tonje Lossius & Førde, Reidun (2018). Forskeren forklarer: Store holdningsvariasjoner til tvang blant fagfolk. [Internet]. Erfaringskompetanse.no. Full text in Research Archive
• Førde, Reidun (2018). Forhåndssamtaler i kommunehelsetjenesten. Foredrag. Full text in Research Archive
• Aasland, Olaf Gjerløw; Pedersen, Reidar; Førde, Reidun & Husum, Tonje Lossius (2018). Tvang og samtykkekompetanse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Full text in Research Archive
• Pedersen, Reidar; Aasland, Olaf Gjerløw; Førde, Reidun & Husum, Tonje Lossius (2018). Uheldig lovverk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Full text in Research Archive
• Aasland, Olaf Gjerløw; Husum, Tonje Lossius; Førde, Reidun & Pedersen, Reidar (2018). Store forskjeller i holdninger til tvang blant fagfolk i psykiatrien. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(9). doi: 10.4045/tidsskr.18.0270. Full text in Research Archive
• Larsen, Berit Hofset & Førde, Reidun (2018). Who leads in the final dance of life? Full text in Research Archive
• Romøren, Maria; Førde, Reidun & Pedersen, Reidar (2017). En pasient - to verdener. p. 28–28. Full text in Research Archive
• Friis, Pål & Førde, Reidun (2017). Forhåndssamtaler = advance care planning. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(6), p. 462–462. doi: 10.4045/tidsskr.16.1049. Full text in Research Archive
• Lillemoen, Lillian; Thoresen, Lisbeth; Sævareid, Trygve Johannes Lereim; Gjerberg, Elisabeth; Førde, Reidun & Pedersen, Reidar (2017). Implementering av forberedende samtaler I sykehjem; erfaringer og foreløpige resultater. Full text in Research Archive
• Lillemoen, Lillian; Thoresen, Lisbeth; Sævareid, Trygve Johannes Lereim; Gjerberg, Elisabeth; Førde, Reidun & Pedersen, Reidar (2017). Forberedende samtaler ved innleggelse I sykehjem. Full text in Research Archive
• Hellebostad, Marit; Syse, Aslak & Førde, Reidun (2017). Når en mindreårig pasient nekter livreddende behandling. doi: 10.4045/tidsskr.17.0247. Full text in Research Archive
• Lillemoen, Lillian; Thoresen, Lisbeth; Sævareid, Trygve Johannes Lereim; Gjerberg, Elisabeth; Førde, Reidun & Pedersen, Reidar (2017). Forberedende samtaler på sykehjem og I allmennpraksis. Full text in Research Archive
• Lillemoen, Lillian; Thoresen, Lisbeth; Sævareid, Trygve Johannes Lereim; Førde, Reidun; Gjerberg, Elisabeth & Pedersen, Reidar (2017). Implementing advance care planning (ACP) in Norwegian nursing homes (NH); Facilitators and barriers. Full text in Research Archive
• Pedersen, Reidar; Gjerberg, Elisabeth & Førde, Reidun (2017). Ethical considerations regarding opioid maintenance treatment and pregnancy. Full text in Research Archive
• Lillemoen, Lillian; Sævareid, Trygve Johannes Lereim; Thoresen, Lisbeth; Gjerberg, Elisabeth; Førde, Reidun & Pedersen, Reidar (2017). Influence of an ACP intervention on documentation of end-of-life issues – a cluster randomized clinical trial. Full text in Research Archive
• Gjerberg, Elisabeth; Lillemoen, Lillian; Førde, Reidun & Molewijk, Bert (2017). Systematisk refleksjon over etiske problemstillinger. In Pedersen, Reidar & Nortvedt, Per (Ed.), Etikk i psykiske helsetjenester. Gyldendal Akademisk. ISSN 9788205481633. p. 320–352. Full text in Research Archive
• Larsen, Berit Hofset & Førde, Reidun (2017). Hvem fører i livets siste dans? Pasientinvolvering ved beslutninger om livsforlengende kreftbehandling. Full text in Research Archive
• Larsen, Berit Hofset & Førde, Reidun (2017). Hvem fører i livets siste dans? Pasientinvolvering ved beslutninger om livsforlengende kreftbehandling. Full text in Research Archive
• Larsen, Berit Hofset & Førde, Reidun (2017). Hvem fører i livets siste dans? Pasientinvolvering ved beslutninger om livsforlengende kreftbehandling. Full text in Research Archive
• Larsen, Berit Hofset & Førde, Reidun (2017). Hvem fører i livets siste dans? Pasientinvolvering ved beslutninger om livsforlengende kreftbehandling. Full text in Research Archive
• Larsen, Berit Hofset & Førde, Reidun (2017). Hvem fører i livets siste dans? Pasientinvolvering ved beslutninger om livsforlengende kreftbehandling. Full text in Research Archive
• Førde, Reidun & Dahlberg, Jørgen (2017). Etikk og jus i helsetjenestene, Indremedisin I & II. Forlaget Vett & Viten AS. ISSN 9788241207402. p. 183–188. Full text in Research Archive
• Pedersen, Reidar & Førde, Reidun (2016). Etikkprofessor: «Må kunne spørre oss hva det er vi redder henne til». [Journal]. VG. Full text in Research Archive
• Førde, Reidun; Gulbrandsen, Pål; Lundeby, Tonje & Larsen, Berit Hofset (2023). Patient autonomy in advanced cancer. A video-based qualitative study of clinical communication in routine hospital visits. Universitetet i Oslo. ISSN 9788234802898. Full text in Research Archive Show summary

  This thesis contributes to the discussion about how to enhance patient autonomy in the case of advanced cancer posing an existential threat to all aspects of being. The aim was to explore 1) what existential concerns patients with advanced cancer disclose during routine hospital visits and how they communicate such concerns, 2) how physicians respond to patients’ existential concerns, and 3) how next-of-kin accompanying the patient contribute to the information exchange. We employed a qualitative research design, studying video-recorded routine outpatient hospital visits involving patients with advanced cancer, using analytic principles from “microanalysis of clinical interaction”. Most patients disclosed existential concerns during the consultation. However, existential concerns were hesitant, subtle, and indirect, typically hidden in biomedical terms. The physicians habitually responded to these concerns by keeping the agenda around biomedical aspects, resulting in that the existential issues remained unaddressed. In most consultations, the patient was accompanied by a next-of-kin, whom the physicians mostly related to as a “supporter on the sidelines” rather than addressing the couple as a team. When claiming the floor, next-of-kin contributed to securing information that would otherwise have been missing. Next-of-kin provided personal and contextual information that can help the physician when aiming to tailor information and care to the individual patient. The thesis points to a potential existential neglect in the physician and in the medical culture. It argues that a narrow focus on patient choice and decision-making may be inadequate, as it does not consider that persons are vulnerable, dependent, and relational. Insights from this thesis can inform the discussion about how physicians can play a role in attending to existential concerns and restoring autonomy in collaboration with the patient, next-of-kin, and the interdisciplinary team.

• Pedersen, Reidar; Førde, Reidun & Jorem, Jacob (2023). Erfaringer med lovendringene om samtykkekompetanse m.m. i psykisk helsevernloven i 2017. Rapport på oppdrag fra Ekspertutvalg om samtykkekompetanse. Universitetet i Oslo. Full text in Research Archive
• Hofmann, Bjørn Morten & Førde, Reidun (2021). Etiske problemstillinger ved etablering av koronasertifikat. Helsedirektoratet. Full text in Research Archive
• Feiring, Eli; Førde, Reidun; Holm, Søren; Norheim, Ole Frithjof; Solberg, Berge & Solberg, Carl Tollef [Show all 9 contributors for this article] (2020). Råd om prioriterte grupper for koronavaksinasjon i Norge. Ekspertgruppe i etikk og prioritering 15. november 2020. Folkehelseinstituttet. Full text in Research Archive
• Feiring, Eli; Førde, Reidun; Holm, Søren; Norheim, Ole Frithjof; Solberg, Berge & Solberg, Carl Tollef [Show all 7 contributors for this article] (2020). The Coronavirus Immunisation Programme Advice on priority groups for coronavirus vaccination in Norway Expert group in ethics and priority setting 15 November 2020. Folkehelseinstituttet. Full text in Research Archive Show summary

  The Norwegian Ministry of Health and Care Services has commissioned the Norwegian Institute of Public Health to organise the national coronavirus immunisationation programme. As a partial delivery of the assignment, the Norwegian Institute of Public Health has established an external expert group in ethics and prioritisation (henceforth: the ethics advisory group). This ethics advisory report describes the external group's working process and conclusions concerning the order of priority of the vaccines in the first phase of the Norwegian Coronavirus Immunisation Programme. The overall objective of this ethics advisory report has been to establish clear goals for what the Coronavirus Immunisation Programme should achieve, as well as to make recommendations for which groups should be given priority in the first phase of the programme. The advisory group has proceeded from values, to goals and lastly to priority categories. The following five values were adopted as the core values to guide prioritisation: equal respect, welfare, equity, trust and legitimacy. Five goals were then proposed and ranked in order of their importance: 1) Reduce the risk of death. 2) Reduce the risk of severe illness. 3) Maintain essential services and critical infrastructure. 4) Protect employment and the economy. 5) re-open society. Based on these values and goals, three categories for prioritisation were established: risk factors for severe illness and death, the infectious situation and occupation. The ethics advisory group has suggested dynamic health priorities based on the Norwegian Government's long-term scenario for the course of the pandemic and recommended that I. risk groups and II. healthcare personnel should be prioritised in pandemic scenarios 1–2a, and that in the event of widespread infection (scenario 2b–), the priority order should instead be I. healthcare personnel, II. risk groups and III. critical societal functions. These three priority groups are in accordance with the values, goals and priority categories proposed by the ethics advisory group in this document. These are preliminary recommendations for the order of priority for coronavirus vaccines in Norway, and the ethics advisory group has taken into account that the recommendations may need to be revised if there are significant changes to the empirical evidence.

• Gjerberg, Elisabeth; Pedersen, Reidar & Førde, Reidun (2017). En etisk drøfting av helsetjenestens håndtering av graviditet og bruk av metadon, buprenorfin eller andre opioider. Helsedirektoratet. Full text in Research Archive

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