Reidar Pedersen

• Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Alnes, Rigmor Grete Einang; Brøderud, Linn & Romøren, Maria [Vis alle 7 forfattere av denne artikkelen] (2026). Healthcare professionals’ experiences of advance care planning conversations with frail older adults admitted to acute geriatric hospital units: a nested qualitative study. BMC Health Services Research. 26. doi: 10.1186/s12913-026-15112-x. Fulltekst i vitenarkiv Vis sammendrag

  Background: Advance care planning can support frail older adults, their next of kin, and healthcare professionals by clarifying patients’ values and preferences and improving communication toward the end of life. Despite these benefits, advance care planning remains underutilized, particularly among frail older adults with complex needs. Limited research has explored healthcare professionals’ experiences with initiating it in acute geriatric settings. As part of a broader research project focused on implementing advance care planning for older adults admitted to acute geriatric hospital units, this study aimed to explore healthcare professionals’ experiences with initiating these conversations. Methods: A qualitative sub-study, nested within a cluster randomized controlled trial, was conducted with implementation teams and other healthcare professionals from the six geriatric units in the intervention arm. They had recently started engaging in advance care planning with frail, acutely ill older patients and their next of kin. Data were collected through four focus groups and four dyadic interviews, involving a total of 24 participants. The data was analysed by using reflexive thematic analysis. Results: Four themes developed as perceived benefits: (1) Amplifies the patients’ voice, (2) Improves communication with next of kin, (3) Influences treatment decisions and may avoid overtreatment (4) Contributes to meaningful work. Two themes developed as perceived challenges: (1) Uncertainty regarding the ACP documentation, (2) ACP conversations require dedicated time and focus. Conclusion: This study revealed that advance care planning conversations in acute geriatric hospital units can amplify patients’ voices and promote their participation in decision-making. Discussions about existential topics appear beneficial and rewarding for patients, next of kin and healthcare professionals, both for in-moment and future decisions. Time constraints may have led to missed opportunities to initiate ACP conversations with patients before the end of life, while documentation issues may have limited their impact on continuity of care. Trial registration https://ClinicalTrials.gov Identifier NCT05681585. Registered 03.01.23.

• Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Alnes, Rigmor Grete Einang; Brøderud, Linn & Romøren, Maria [Vis alle 7 forfattere av denne artikkelen] (2026). Ethical challenges in acute geriatric care and advance care planning: a nested qualitative study. European Geriatric Medicine. ISSN 1878-7649. s. 1–11. doi: 10.1007/s41999-026-01563-2. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Ethical challenges are common in geriatrics, and moral dilemmas and conflicting interests can arise in advance care planning (ACP). Respecting the wishes of frail, acutely ill older patients while acting in their best interests can be challenging. This study was nested within a cluster randomized controlled trial aimed at implementing ACP in acute geriatric hospital units. The aim of this study was to explore clinicians’ experiences of ethical challenges in geriatric units before and during this implementation project. Methods Eight semi-structured interviews—four focus groups and four dyadic interviews—were conducted with a total of twenty-four participants, including implementation teams and other clinicians from the six intervention units. These participants had engaged in ACP with frail, acutely ill older patients and, preferably, their next of kin. The data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results Four themes were developed: (1) navigating prognostic uncertainty while sustaining hope, (2) providing information that enables understanding and participation, (3) managing family disagreements and emotional strain, and (4) preserving dignity towards the end of life. The findings indicate that ethical challenges were often mitigated rather than intensified through ACP conversations. Conclusion Ethical challenges in acute geriatric care arose when patient autonomy was limited by cognitive impairment, unclear preferences, or family disagreement. Earlier preparation of patients and next of kin through ACP could facilitate early identification of potential disagreements and provide a stronger foundation for dialogue in acute situations.

• Feiring, Ingvild Hjorth; Pedersen, Reidar; Kirkevold, Øyvind; Surr, Claire; Sabbata, Kevin De & Steyaert, Jan [Vis alle 13 forfattere av denne artikkelen] (2026). Is capacity to consent to healthcare a uniformly defined concept? Insights from a document analysis of laws and national guidelines across six European countries. International Journal of Law and Psychiatry. ISSN 0160-2527. 108. doi: 10.1016/j.ijlp.2026.102235. Fulltekst i vitenarkiv
• Norheim, Irene; Røssberg, Jan Ivar; Selle, Maria Lie; Woodberry, Kristen; O'Brien, Mary & Pedersen, Reidar [Vis alle 11 forfattere av denne artikkelen] (2026). Expressed emotions and caregiving appraisals among relatives of patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 26(1). doi: 10.1186/s12888-026-07868-7. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Norheim, Irene; Pedersen, Reidar; Selle, Maria Lie; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Vis alle 13 forfattere av denne artikkelen] (2025). Effectiveness of implementing family involvement on patient outcomes in individuals with psychotic disorders: a pragmatic cluster randomised controlled trial. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07501-z. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background The purpose of this sub-study, as part of the Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, was to examine the effectiveness of family interventions (FIs) implemented through an implementation support program (ISP) on patients’ outcomes. Methods The IFIP trial is a cluster randomised controlled trial where 15 Community Mental Health Centre units were randomly allocated either to the ISP, which included FIs as clinical interventions, implementation strategies, and implementation interventions, or to treatment as usual (TAU). In the control arm, patients could have access to FIs. Patients with psychotic disorders in both arms were asked to complete questionnaires at inclusion, 6- and 12 months. The primary outcome was patients’ difficulties in interpersonal relationships measured with the Relationships subscale of Behaviour and Symptom Identification scale. The secondary outcomes were patients’ mental health and functioning, perceived expressed emotions, recovery, and quality of life. Linear mixed-effects models were used to analyse differences in change over time between the two arms. Results We included 231 patients (135 from the intervention units; 96 from the control units). Except for the first 24% of the 6 months questionnaires, the 6- and 12-month data were collected during the COVID-19 pandemic. There were no significant differences in the primary outcome, difficulties in interpersonal relationships at 12 months, between the intervention and control arms (Cohen’s d = -0.19, p  = 0.2). The secondary outcomes showed less perceived criticism from the relatives (Perceived Criticism sub-score; d = − 0.4, p  = 0.01) and reduced difficulties in overall functioning (Health of the Nation Outcome Scale; d = − 0.29, p  = 0.01) in the intervention arm compared to the control arm at 12 months. Conclusion The FIs, implemented through the ISP, did not achieve significant decreases in patients’ difficulties with interpersonal relationships. However, this sub-study indicates that FIs in routine mental health practices can nurture a more positive family environment and enhance the patient’s process toward improved functioning. The complexity of the study design, and the restrictions due to COVID-19, may have diminished the implementation and effectiveness of the measured FIs for the patients. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 2019-02-28.

• Brøderud, Linn; Romøren, Maria; Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Thoresen, Lisbeth & Pedersen, Reidar (2025). Barriers and facilitators in implementing advance care planning for frail older patients acutely admitted to geriatric hospital units: a nested qualitative study. Frontiers in Health Services. 5. doi: 10.3389/frhs.2025.1646541. Fulltekst i vitenarkiv Vis sammendrag

  Background: Appropriate communication with patients is increasingly crucial in a growing elderly population to prevent both over- and undertreatment. Advance care planning (ACP) is recognized as a valuable communication process for patients, their relatives and healthcare professionals that facilitates future care and medical decision-making. Despite its importance, the uptake remains low, particularly among frail, older patients in hospitals. Methods: This qualitative substudy is nested within a cluster randomized controlled trial. Data collection involved eight semi-structured interviews conducted in acute geriatric hospital units receiving our implementation support program, along with informal data from interactions with the units during the implementation process. The aim was to explore healthcare professionals' perspectives on the barriers and facilitators to ACP implementation and their experiences with the implementation support program. A semi-structured interview guide was used. The data was analyzed using content analysis. Results: Factors influencing ACP implementation were identified at three levels: a) the organizational level, b) the national level, and c) the clinical level. Participants recognized the critical role of timing, context, and patients' capacity. However, there was meaningful opportunities for ACP conversations in acute geriatric units. Overall, the experiences underscored the complex interplay of individual motivation and interest, organizational support, prioritization, available time and resources, and systemic factors that influence the integration of ACP into clinical practice, as well as the fact that research can act as both a barrier and a facilitator in implementation efforts. Discussion: This study illustrates the significant challenges in implementing ACP in acute hospital care. Despite a generally positive perception of ACP, its implementation was hindered by barriers such as overwhelming workload, production-oriented healthcare, the biomedical model, and lack of prioritization. These factors creates a cycle where short-term demands overshadow preventive and patient-centered interventions, limiting their perceived and documented benefits. Breaking this cycle will likely require targeted investment in the implementation of complex interventions.

• Westbye, Siri Færden; Romøren, Maria; Ahmed, Marc; Hermansen, Karin Berg; Brøderud, Linn & Wahl, Astrid Klopstad [Vis alle 9 forfattere av denne artikkelen] (2025). Measuring the level of implementation of advance care planning – a fidelity-based cross-sectional study. Frontiers in Health Services. 5. doi: 10.3389/frhs.2025.1629242. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Advance care planning (ACP) is supported by evidence, legal and ethical principles and ACP guidelines. However, this complex intervention is often poorly implemented. This article presents a novel fidelity scale to measure the implementation of ACP and reports the preliminary testing of the scale at baseline in a larger trial aiming at implementing ACP in hospitals in Norway. Method The research design conducted was a cross-sectional measurement of fidelity to guidelines, conducted in 12 geriatric hospital units in Norway recruited using purposive sampling. The sample size for the larger trial was determined, based on prior research, to be at least four clusters in each arm. Due to the possibility of unit drop-out during the project period and to secure sufficient power, we included six units in the intervention arm and six in the control arm. For the baseline measurement we developed an ACP fidelity scale including three subscales: implementation, quality and penetration rate, each with 4–11 items. We ensured face and content validity through input from relevant theories and research, experts and users. Items were scored from 1 to 5, with 1 indicating no implementation and 5 indicating full implementation. Data was analyzed using descriptive statistics, Cronbach's alpha and calculation of interrater reliability for the scales. Further psychometric testing could not be conducted at this stage due to the lack of variance in the items. Results The mean score for the implementation subscale was 1.213, with a median of 1, a standard deviation (SD) of 0.08, a standard error (SE) of 0.01, a variance of 0.01, and a range of 0.28 (minimum 1.14 and maximum 1.42). The scores in the subscale showed that none of the units had recommended implementation measures. Only a few professionals reported they had heard of ACP, but not the whole staff. Cronbach's alpha could not be estimated due to the lack of variation in the scores for this subscale. On the quality subscale, which assesses whether ACP is practiced in accordance with practice guidelines, the mean score was 1.11, the median was 1, the SD was 0.48, the SE was 0.06, the variance was 0.13, and the range was 1.27 (minimum 1 and maximum 2.27). The scores in this subscale showed that ACP was practiced sporadically by the palliative care team in only one unit, while the other staff did not engage in this practice at all. Cronbach's alpha for the subscale on quality was 0.887 (11 items) showing an acceptable internal consistency. For the penetration rate subscale, which measures how widespread the practice is, the mean score was 1.08, the median was 1, the SD was 0.28, the SE was 0.05, the variance was 0.08, and the range was from a minimum of 1 to a maximum of 2. Among the total number of admitted geriatric patients, only 10% had received ACP in only one of the 12 units. Also, for this subscale, the model for Cronbach's alpha could not be applied. There was little variation in the low measurements, thus the interrater reliability was high, reflected in the Intraclass Correlation Coefficient (ICC). The ICC was 0,916 [−0,721,0.976] for the implementation subscale, 1.00 for the quality subscale, and 1.00 for the penetration rate subscale. Conclusion Our findings indicate very low implementation of ACP in acute geriatric hospital units in Norway. The newly developed ACP fidelity scale has the potential to serve as an important tool for improving the quality of healthcare services for older patients. However, more data is needed to validate the psychometric properties of the scale. Our study should be considered as a preliminary study, and the scale should be used with caution as long as its properties are not well validated. Clinical Trial Registration ClinicalTrials.gov , NCT05681585.

• Hermansen, Karin Berg; Alnes, Rigmor Grete Einang; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Westbye, Siri Færden & Romøren, Maria [Vis alle 7 forfattere av denne artikkelen] (2025). Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-12609-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Acutely ill and frail older adults and their next of kin are often poorly involved in planning of decisions regarding treatment and care during the final phase of life. Although advance care planning is a well-documented tool to strengthen patient autonomy and involve next of kin, it remains underused in hospital settings. We present a qualitative sub-study embedded in a cluster-randomized controlled trial, whose purpose was to implement advance care planning in Norwegian geriatric units. Frail, home dwelling older adults acutely admitted to geriatric hospital units were invited to participate in advance care planning together with their next of kin. The aim of this study was to explore next of kin experiences of advance care planning. Methods The study has a qualitative design, based on individual semi-structured interviews with 13 next of kin. A purposive sampling was used to select next of kin who had recently participated in advance care planning from five geriatric units in the intervention arm. The analysis was conducted using reflexive thematic analysis by Braun and Clarke. Results Four themes were developed from the analysis; (1) Being informed and involved through open communication; (2) Getting prepared for what’s to come; (3) The importance of the next of kin role in providing support and facilitation; (4) The need for documentation and collaboration across service levels. Conclusion Advance care planning appears to provide a sense of security among next of kin by addressing their information needs regarding the patient’s prognosis, encouraging discussions on possible courses of action, and clarifying the patient’s end-of-life preferences. Next of kin played a crucial role in supporting the patient’s autonomy, and they considered the hospital stay as an ideal time for advance care planning. Increased awareness of their role as next of kin seems to enhance agreement and trust when confronting challenging situations and existential questions. Trial registration ClinicalTrials.gov Identifier NTCT05681585. Registered 03.01.23.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Agledahl, Kari Milch & Pedersen, Reidar (2024). Ethics in the operating room: a systematic review. BMC Medical Ethics. 25(1). doi: 10.1186/s12910-024-01128-7. Fulltekst i vitenarkiv Vis sammendrag

  Background/Objective - The act of surgery involves harming vulnerable patients with the intent that the results will improve their health and, ultimately, help the patients. Such activities will inevitably entail moral decisions, yet the ethics of surgery has only recently developed as a field of medical ethics. Within this field, it is striking how few accounts there are of actions within the operating room. The aim of this systematic review was to investigate how much of the scientific publications on surgical ethics focus on what take place inside the operating room and to explore the ethical issues included in the publications that focus on medical ethics in the operating room.<p> <p>Methods - We conducted a systematic search of the Medline and Embase databases using a PICO model and the search terms “surgery”, “ethics” and “operating room”. Papers were included if they focused on doctors, entailed activities inside the operating room and contained some ethical analysis. Thematic synthesis was used for data extraction and analysis.<p> <p>Findings - Fewer than 2% of the scientific publications on surgical ethics included activities inside the operating room. A total of 108 studies were included in the full-text analysis and reported according to the RESERVE guidelines. Eight content areas covered 2/3 of the included papers: DNR orders in the OR, overlapping surgery, donation of organs, broadcasting live surgery, video recordings in the OR, communication/teamwork, implementing new surgical technology, and denying blood to Jehovah’s Witness.<p> <p>Discussion/Conclusions - This systematic review indicates that only a small fraction of scientific publications on the ethics of surgery focus on issues inside the operating room, accentuating the need for further research to close this gap. The ethical issues that repeatedly arose in the included papers included the meaning of patient autonomy inside the operating room, the consequences of technological advances in surgery, the balancing of legitimate interests, the dehumanising potential of the OR, and the strong notion of surgeon responsibility.

• Romøren, Maria; Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita; Westbye, Siri Færden & Wahl, Astrid Klopstad [Vis alle 10 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Ihle-Hansen, Hege Beate; Pedersen, Reidar; Westbye, Siri Færden; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita & Larsen, Marie Hamilton [Vis alle 9 forfattere av denne artikkelen] (2024). Patient preferences in geriatric wards, a survey of health care professionals’ practice, experience and attitudes. European Geriatric Medicine. ISSN 1878-7649. 15, s. 153–158. doi: 10.1007/s41999-023-00922-7. Fulltekst i vitenarkiv Vis sammendrag

  Purpose We aimed to identify whether health care professionals (HCP) examine their patient and next-of-kin preferences, and to study whether medical decisions follow these preferences. Method A cross-sectional web-based survey was conducted with multidisciplinary HCP from 12 geriatric wards in the South-Eastern Norway Regional Health Authority. Results Of the 289 HCPs responding (response rate 61%), mean age 37.8 years (SD 11.3), 235 (81.3%) women, 12.4 (SD 9.6) years of experience and 67 (23.2%) medical doctors, only half report clarifying patients’ preferences. The majority reported that they did not inform, involve and treat in line with such preferences. However, 53% believe that HCP, patients and next-of-kin should make clinical decisions together. Discussion Our findings indicate a lack of engagement in conversation and inclusion of patient preferences when providing health interventions in geriatric wards. Measures for change of culture are needed.

• Norheim, Irene; Pedersen, Reidar; Selle, Maria; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Vis alle 12 forfattere av denne artikkelen] (2024). Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives’ outcomes and family interventions received. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1381007. Fulltekst i vitenarkiv Vis sammendrag

  Background: Family interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives’ outcomes and received FI. Methods: A cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives’ primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives’ secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients’ outcomes will be reported elsewhere. Results: In total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives’ satisfaction with health service support, showed a non-significant improvement (Cohen’s d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen’s d = -0.23, p = 0.03). Conclusion: The increased support from clinicians throughout FI reduced the relatives’ perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives’ outcomes. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03869177.

• Ihle-Hansen, Hege Beate; Ihle-Hansen, Håkon; Rostoft, Siri; Munkhaugen, John; Westbye, Siri Færden & Romøren, Maria [Vis alle 13 forfattere av denne artikkelen] (2024). Forhåndssamtaler om siste livsfase. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(13). doi: 10.4045/tidsskr.24.0105. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det foreligger nye nasjonale faglige råd om forhåndssamtaler om siste livsfase. Trygghet i kommunikasjon er viktig for implementering. Formålet med denne studien var å kartlegge helsepersonells selvopplevde trygghet i kommunikasjon om fremtidig helsehjelp og pasientens ønsker i livets sluttfase. Materiale og metode: Helsepersonell ved tolv geriatriske enheter i Helse Sør-Øst besvarte en nettbasert spørreundersøkelse høsten 2022. De fire svaralternativene for selvrapportert trygghet – «lite trygg», «nokså trygg», «meget trygg» og «svært trygg» – er slått sammen til to kategorier: «begrenset trygghet» («lite trygg» og «nokså trygg») og «høy trygghet» («meget trygg» og «svært trygg»). Resultater: Vi fikk svar fra 289 av 470 (61,5 %) av de inviterte, med en gjennomsnittsalder på 37,8 ± 11,3 år, hvorav 217 av 289 (75 %) hadde mer enn fem års yrkeserfaring. Blant legene rapporterte 15 av 67 (22 %) begrenset trygghet i kommunikasjon om «fremtidig forverring av pasientens helsetilstand», 20 av 67 (30 %) om «livsforlengende behandling» og 13 av 67 (19 %) om «ønsker for livets sluttfase». For annet helsepersonell var tilsvarende responser 119 av 222 (54 %), 140 av 222 (63 %) og 109 av 222 (49 %). Fortolkning: Egenvurdert trygghet i kommunikasjon om fremtidig forverring, fremtidig helsehjelp og pasientens egne ønsker i livets sluttfase varierer, og er begrenset blant mye helsepersonell i geriatriske enheter. Det synes nødvendig med tiltak for å øke tryggheten i kommunikasjon og implementering av forhåndssamtaler i helsetjenesten. Hovedfunn: Blant leger oppga 20 av 67 (30 %) begrenset trygghet i kommunikasjon om «fremtidig helsehjelp», mens av annet helsepersonell svarte 140 av 222 (63 %) det samme. For kommunikasjon om «ønsker for livets siste fase» fant vi at 13 av 67 (19 %) av legene og 109 av 222 (49 %) av annet helsepersonell oppga begrenset trygghet.

• Hestmark, Lars; Romøren, Maria; Hansson, Kristiane Myckland; Heiervang, Kristin Sverdvik & Pedersen, Reidar (2023). Clinicians’ perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study. Frontiers in Psychiatry. 14, s. 1–12. doi: 10.3389/fpsyt.2023.1175557. Fulltekst i vitenarkiv Vis sammendrag

  Background: Family involvement in mental health care ranges from basic practices to complex interventions such as Family psychoeducation, the latter being a well-documented treatment for psychotic disorders. The aim of this study was to explore clinicians’ perceptions of the benefits and disadvantages of family involvement, including possible mediating factors and processes. Methods: Nested in a randomised trial, which purpose was to implement Basic family involvement and support and Family psychoeducation in Norwegian community mental health centres during 2019–2020, this qualitative study is based on eight focus groups with implementation teams and five focus groups with ordinary clinicians. Using a purposive sampling strategy and semi-structured interview guides, focus groups were audio-recorded, transcribed verbatim, and analysed with reflexive thematic analysis. Results: Four main themes were identified as perceived benefits: (1) Family psychoeducation—a concrete framework, (2) Reducing conflict and stress, (3) A triadic understanding, and (4) Being on the same team. Themes 2–4 formed an interconnected triad of mutually reinforcing elements and were further linked to three important clinician-facilitated sub-themes: a space for relatives’ experiences, emotions and needs; a space for patients and relatives to discuss sensitive topics and an open line of communication between clinician and relative. Although far less frequent, three main themes were identified as perceived disadvantages or challenges: (1) Family psychoeducation—occasional poor model fit or difficulties following the framework, (2) Getting more involved than usual, and (3) Relatives as a potentially negative influence—important nonetheless Conclusions: The findings contribute to the understanding of the beneficial processes and outcomes of family involvement, as well as the critical role of the clinician in achieving these and possible challenges. They could also be used to inform future quantitative research on mediating factors and implementation efforts.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Brøderud, Linn Benita; Pedersen, Reidar & Magelssen, Morten (2023). Balancing burdens of infection control: Norwegian district medical officers’ ethical challenges during the COVID-19 pandemic. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09573-7. Fulltekst i vitenarkiv Vis sammendrag

  Background In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic. Methods The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach. Results Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other. Conclusions The DMOs have a central role in the municipality’s handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.

• Hansson, Kristiane Myckland; Romøren, Maria; Hestmark, Lars; Heiervang, Kristin Sverdvik; Weimand, Bente Margrethe & Norheim, Irene [Vis alle 7 forfattere av denne artikkelen] (2023). “The most important thing is that those closest to you, understand you”: a nested qualitative study of persons with psychotic disorders’ experiences with family involvement. Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1138394. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Family interventions constitute effective treatment for persons with psychotic disorders. However, the active ingredients and beneficial processes of these interventions are insufficiently examined, and qualitative explorations of patients` experiences are lacking. This study was nested in a cluster randomised trial that implemented national guidelines on family involvement in Norwegian community mental health centres, including family psychoeducation and basic family involvement and support. The aim of this sub-study was to explore how patients with psychotic disorders experience systematic family involvement, and its significance. Methods We conducted semi-structured, individual interviews with 13 persons with a psychotic disorder after systematic family involvement. The participants were recruited through purposive sampling. Qualitative content analysis guided the analysis. Results Participants reported overall positive experiences with systematic family involvement. It was significant that the relatives increasingly understood more about psychosis and their situation, while they themselves also gained more insight into the relatives` situation. The participants emphasised the need to enable both patients and relatives to safely share experiences in a containing space, led by professionals. Shared understanding and awareness of each other’s situation further improved communication, coping with the illness, reduced stress, and stimulated a more caring family environment. The therapist seemed crucial to facilitate these beneficial communication processes, and also to provide continuous support to the relatives. Reported challenges included that the participants felt vulnerable in the initial phase, a need for tailored approaches, and too late start-up. Conclusion Findings from this study suggest that persons with psychotic disorders may benefit greatly from participating in systematic family involvement. This study also gives new insight into possible mediators of positive outcomes both for the patients and the relatives. Systematic family involvement should be implemented a standard approach in the early phase of the disease, using a step-wise and tailored process.

• Wikstøl, David; Horn, Morten Andreas; Pedersen, Reidar & Magelssen, Morten (2023). Citizen attitudes to non-treatment decision making: a Norwegian survey. BMC Medical Ethics. 24(1). doi: 10.1186/s12910-023-00900-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Decisions about appropriate treatment at the end of life are common in modern healthcare. Non-treatment decisions (NTDs), comprising both withdrawal and withholding of (potentially) life-prolonging treatment are in principle accepted in Norway. However, in practice they may give rise to significant moral problems for health professionals, patients and next of kin. Here, patient values must be considered. It is relevant to study the moral views and intuitions of the general population on NTDs and special areas of contention such as the role of next of kin in decision-making. Methods Electronic survey to members of a nationally representative panel of Norwegian adults. Respondents were presented with vignettes describing patients with disorders of consciousness, dementia, and cancer where patient preferences varied. Respondents answered ten questions about the acceptability of non-treatment decision making and the role of next of kin. Results We received 1035 complete responses (response rate 40.7%). A large majority, 88%, supported the right of competent patients to refuse treatment in general. When an NTD was in line with the patient’s previously expressed preferences, more respondents tended to find NTDs acceptable. More respondents would accept NTDs for themselves than for the vignette patients. In a scenario with an incompetent patient, clear majorities wanted the views of next of kin to be given some but not decisive weight, and more weight if concordant with the patient’s wishes. There were, however, large variations in the respondents’ views. Conclusion This survey of a representative sample of the Norwegian adult population indicates that attitudes to NTDs are often in line with national laws and guidelines. However, the high variance among the respondents and relatively large weight given to next of kin’s views, indicate a need for appropriate dialogue among all stakeholders to prevent conflicts and extra burdens. Furthermore, the emphasis given to previously expressed opinions indicates that advance care planning may increase the legitimacy of NTDs and prevent challenging decision-making processes.

• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Vis alle 9 forfattere av denne artikkelen] (2023). Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 50(3), s. 520–533. doi: 10.1007/s10488-023-01255-0. Fulltekst i vitenarkiv Vis sammendrag

  Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.

• Hem, Marit Helene; Molewijk, Albert Christiaan; Weimand, Bente Margrethe & Pedersen, Reidar (2023). Patients with severe mental illness and the ethical challenges related to confidentiality during family involvement: a scoping review. Frontiers in Public Health. 10, s. 1–14. doi: 10.3389/fpubh.2022.960815. Fulltekst i vitenarkiv Vis sammendrag

  Background: Despite evidence on the significant potential value of family involvement during the treatment of patients with severe mental illness, research has shown that family involvement is largely underused. The duty of confidentiality is reported to be a key barrier to family involvement. To develop more insight into this barrier, this scoping review focuses on the following question: What are the reported ethical challenges related to confidentiality when involving family in the treatment of patients with severe mental illness? Methods: A systematic search into primary studies was conducted using the following databases: Medline (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science core collection (Clarivate). The PICO (Population, Intervention, Comparison, Outcome) scheme and qualitative content analysis were used to make the ethical challenges more explicit. Results: Twelve studies—both qualitative and quantitative—were included. We identified the following main categories of ethical challenges: (1) the best interest of family members vs. confidentiality, (2) the patient's best interest vs. the right to confidentiality, (3) patient trust and alliance as a reason not to involve the relatives or not to share information, and (4) using confidentiality as a smokescreen. We also identified several subcategories and illustrative and concrete examples of ethical challenges. Conclusions: Through a systematic examination, we discovered various types of ethical challenges related to confidentiality when involving the family in the treatment of patients with severe mental illness. However, research on these ethical challenges and the constituents of these challenges remains limited and often implicit. An ethical analysis will create knowledge which may facilitate a more balanced and nuanced approach to respecting the principle of confidentiality while also considering other moral principles. The duty of confidentiality does not always have to be a major barrier to family involvement; this insight and using this ethical analysis in the training of healthcare professionals may benefit the patient, the family, and the services.

• Westbye, Siri Færden; Rostoft, Siri; Romøren, Maria; Thoresen, Lisbeth; Wahl, Astrid Klopstad & Pedersen, Reidar (2023). Barriers and facilitators to implementing advance care planning in naïve contexts - where to look when plowing new terrain? BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-04060-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Advance care planning (ACP) is a way of applying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view, and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. Methods Qualitative interviews were chosen to enable an explorative, flexible design. Qualitative interviews were conducted with 40 health care professionals and chief physicians in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke’s strategy for thematic analysis. Results The main reported barriers were the lack of time and space, a lack of culture and leadership legitimizing ACP, lack of common communication systems, and unclear responsibility about who should initiate, resulting in missed opportunities and overtreatment. Policy development, public and professional education, and standardization of documentation were reported as key to facilitate ACP and build trust across the health care system. Conclusions Progressively changing the education of health professionals and the clinical culture are major efforts that need to be tackled to implement ACP in unfamiliarized contexts, particularly in contexts where patient's wishes are not legally binding. This will need to be tackled through rectifying the misconception that ACP is only about death, and providing practical training for health professionals, as well as developing policies and legislation on how to include patients and caregivers in the planning of care.

Se alle arbeider i NVA

• Cairns, Patrick; Knapstad, Ida Katrine; Ishaq, Bushra; Bache-Mathiesen, Lena Kristin; Wangensteen, Urd Teresia & Pedersen, Reidar [Vis alle 10 forfattere av denne artikkelen] (2026). Norway Update – Nordic ChiCaP symposium. Fulltekst i vitenarkiv Vis sammendrag

  Conference talk at symposium for members of the Nordic Childhood Cancer Predisposition collaboration group – 13th-14th April 2026.

• Cairns, Patrick; Ishaq, Bushra; Knapstad, Ida Katrine; Pedersen, Reidar; Hofmann, Bjørn Morten & Wangensteen, Urd Teresia [Vis alle 10 forfattere av denne artikkelen] (2026). Hopes and Concerns of Adolescent Patients and their Caregivers Related to Genetic Predisposition Testing in Childhood Cancer Care: A Three-Year Longitudinal Follow-Up. Fulltekst i vitenarkiv
• Ishaq, Bushra; Cairns, Patrick; Knapstad, Ida Katrine; Bache-Mathiesen, Lena Kristin; Bentzen, Heidi Beate & Pedersen, Reidar [Vis alle 10 forfattere av denne artikkelen] (2025). The PROTECT-CARE study: Psychosocial, communication, ethical and legal aspects of childhood cancer predisposition testing in clinical care. Fulltekst i vitenarkiv
• Cairns, Patrick; Ishaq, Bushra; Knapstad, Ida Katrine; Hofmann, Bjørn Morten; Bentzen, Heidi Beate & Wangensteen, Urd Teresia [Vis alle 9 forfattere av denne artikkelen] (2025). Exploring psycho-social-ethico-legal issues related to genetic predisposition testing in pediatric cancer – the PROTECT-CARE study. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Hvordan unngå bruk av tvang i daglig pasientkontakt - Å møte motstand. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Lovendringer i pasient- og brukerrettighetsloven og psykisk helsevernlovenfom 1. juni 2026. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Kasuistikker - Arkiv og database e.l. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Veileder behandlingsavklaringer, forhåndssamtaler og kjernejournal/kritisk info. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Prioriteringsmeldingen - kommentarinnlegg. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Paneldialog – case. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Etiske perspektiv på gode valg i livets dilemmaer. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Vurdering av samtykkekompetanse. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Når sårbare voksne utsettes for vold, overgrep eller utnytting - jussen, etiske dilemma, prinsipper og systematiske drøftinger. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Avslutning og veien videre. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Om prosjektet «Implementering av forhåndssamtaler i akuttgeriatriske enheter». Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Behandlingsavklaringer, dødshjelp og ny nasjonal veileder. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Beslutningskompetanse, sykdomsinnsikt og lovendringsforslaget. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Medisinsk etikk og palliasjon. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Forhåndssamtaler - innføring og praktiske øvelser. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Pårørendesamarbeid og sosial innovasjon i velferdstjenestene. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Dialogmøte om sykehjemsundersøkelse. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Den neste teknologirevolusjonen? Paneldiskusjon. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Vektlegger Helsams sterke internasjonale profil. [Internet]. Helsams nettsider. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Hva er innovasjon – og hvilken rolle kan universitetet spille? [Internet]. Helsams nettsider. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Nikoline (29) ble holdt fast og lagt i belter: – Følte meg som et dyr i et bur. [Journal]. Tønsberg Blad. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Hun ble lagt i belter, holdt fast og tvangsernært. [Journal]. Aftenposten. Fulltekst i vitenarkiv
• Pedersen, Reidar (2025). Beslutningskompetanse, sykdomsinnsikt og lovendringsforslaget. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Ivaretakelse av pasientens autonomi og samarbeid med pårørende. Fulltekst i vitenarkiv
• Pedersen, Reidar & Enoksen, Kjellaug (2024). Forhåndssamtaler – på sykehjem og andre steder i helsetjenesten. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Samtykkekompetanse, etikk og tvang. Fulltekst i vitenarkiv
• Pedersen, Reidar; Heggestad, Anne Kari Tolo & Kirkevold, Øyvind (2024). Bruk av tvang i sykehjem i Oslo. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Welcome, introduction, and information about further work and applications. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Etiske utfordringer ved bruk av tvang. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Implementering av forhåndssamtaler for geriatriske pasienter - En klynge-randomisert studie i Helse Sør-Øst. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Komplekse intervensjoner og implementering – grunnleggende begreper, spørsmål og etikk. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Implementering av forhåndssamtaler for geriatriske pasienter - En klynge-randomisert studie i Helse Sør-Øst. Fulltekst i vitenarkiv
• Romøren, Maria & Pedersen, Reidar (2024). Pårørendesamarbeid og taushetsplikten. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Hvor langt går ø-hjelpsplikten for pasient med kronisk suicidalitet? Kommentarinnlegg. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Hvilke pasienter skal vi gi utredning og behandling? Om prioriteringer i psykiatrisk spesialisthelsetjeneste. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Hvordan håndtere etiske utfordringer i folkehelsearbeidet og i helsetjenestene? Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Etiske utfordringer i rusmedisin m.m. Fulltekst i vitenarkiv
• Solberg, Carl Tollef & Pedersen, Reidar (2024). Palliativ psykiatri – hva betyr det og hvilken rolle bør det ha i psykisk helsevern? Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Etikk, tvang og menneskerettigheter. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). The legislation on assessing capacity to consent in Norway. Fulltekst i vitenarkiv
• Pedersen, Reidar (2024). Klinisk etikk og etikk ved livets slutt. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Velkommen til train the trainer kurs - forhåndssamtaler. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Presentation of other social innovation measures and ideas based upon the IFIP/BPS-project. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). How to improve graduate and post-graduate health educations on family involvement based on the IFIP/BPS-results? Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Information about opportunities to disseminate knowledge from the project. Fulltekst i vitenarkiv
• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Vis alle 9 forfattere av denne artikkelen] (2023). Correction to: Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial (Administration and Policy in Mental Health and Mental Health Services Research, (2023), 50, 3, (520-533), 10.1007/s10488-023-01255-0). Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-023-01291-w. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Hvordan skape bærekraft i pårørendesamarbeidet? Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Betydning av vilkåret om manglende samtykkekompetanse for pårørende og noen mer generelle kommentarer - til Samtykkeutvalget. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Etikk og menneskerettigheter. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Medicinsk etik og palliation. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Scaling up the implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP-SPARK) - Status and challenges. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Når KEK-saker blir mediemat - SMEs rolle. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Implementering av nasjonale anbefalinger for pårørendesamarbeid - erfaringer og resultater fra BPS(Bedre pårørendesamarbeid)-prosjektet. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Samfunnsinnovasjoner: Forskning driver samfunnet framover. [Journal]. Apollon. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Erfaringer med samtykkekompetanse i psykisk helsevern. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Etiske perspektiver i psykiatrisk praksis. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Scaling up the implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP-SPARK) - Activities so far. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Betydning av systematisk pårørendesamarbeid. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Velkommen. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Ny forskning om pårørendesamarbeid – viktig for pasientene, pårørende og samfunnet. [Internet]. https://www.med.uio.no/helsam/om/aktuelt/aktuelle-saker/2023. Fulltekst i vitenarkiv
• Pedersen, Reidar; Heggestad, Anne Kari Tolo & Kirkevold, Øyvind (2023). Tvungen helsehjelp ved sykehjem i Oslo. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Avslutning av helsehjelp hos pasienter med psykiske lidelser. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Deling av BPS-ressurser, veien videre og takk for i dag! Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Om Bedre Pårørendesamarbeid (BPS)-prosjektet. Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Hvordan kan Erfaringskompetanse bidra til erfaringsbasert kunnskaps- og kompetanseutvikling for tjenestene, pasientene og de pårørende? Fulltekst i vitenarkiv
• Pedersen, Reidar (2023). Bedre pårørendesamarbeid: Kliniske intervensjoner. Fulltekst i vitenarkiv
• Hofstad, Tore; Nyttingnes, Olav; Markussen, Simen; Johnsen, Erik; Killackey, Eoin & McDaid, David [Vis alle 21 forfattere av denne artikkelen] (2023). Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: Protocol for a controversies in psychiatry research project. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. 33(1). doi: 10.1002/mpr.1980. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry-based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. Methods: By using the natural variation in health providers' preference for compulsory care as a source of quasi-randomisation we will estimate causal effects of compulsory care on short- and long-term trajectories. Conclusions: This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group.

• Kirkevold, Øyvind; Heggestad, Anne Kari Tolo & Pedersen, Reidar (2023). Kartlegging av tvungen helsehjelp ved sykehjem i Oslo - Rapport på oppdrag fra Oslo kommune ved Byrådsavdelingen for helse, eldre og innbyggertjenester. Universitetet i Oslo. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Wien, Pål Anders; Solberg, Carl Tollef & Pedersen, Reidar (2023). Vold som en del av arbeidshverdagen hos vernepleiere: En tematisk analyse av semistrukturerte dybdeintervju. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det er gjort lite forskning på vernepleieres erfaringer i møte med tvang og vold i deres daglige virke. Det meste av forskning på dette er gjort innen psykisk helse, i akutt- og langtids institusjoner. Vernepleiere kan inngå som en del av helsepersonell som har arbeid ved slike institusjoner. Vernepleierutdanningen er unik for Norge. Dette er en utdanning spesielt rettet mo noe som fører til at det ikke eksisterer forskning fra andre land om spesifikt denne gruppen helsepersonell. Metode: Studien er basert på fire individuelle semistrukturerte dybdeintervju av fire vernepleiere med lang erfaring med arbeid. Intervjuene ble fortolket ved hjelp av tematisk analyse. Resultater: Vernepleierne velger å stå i en arbeidshverdag med vold over tid med mål om å komme i posisjon til å jobbe faglig med å etablere selvhjelpsferdigheter for å øke personens autonomi. En konsekvens av økt autonomi er lavere forekomst av vold. Å ha dette målet klart for seg er viktig for at vernepleiere kan stå i en arbeidshverdag med vold. Til tross for denne, og andre strategier opplever vernepleierne fortsatt å være redd for å bli utsatt for vold og trusler om vold på jobb.

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