Siri Færden Westbye

• 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.

• 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.

• 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.

• 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.

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• Westbye, Siri Færden (2026). Forhåndssamtaler – på sykehjem og andre steder i helsetjenesten. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2026). Forhåndssamtaler. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2023). Implementering av forhåndssamtaler på sykehus: Hemmere og fremmere og iboende etiske dilemmaer. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2023). Forhåndssamtale - hva er det og hvordan gjør vi det? Fulltekst i vitenarkiv
• Westbye, Siri Færden (2023). Implementering av forhåndssamtaler: hemmere og fremmere. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Samtykkekompetanse og tvangsbehandling i somatikken. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Implementering av forhåndssamtaler for geriatriske pasienter - En klynge-randomisert studie i Helse Sør-Øst. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Implementering av forhåndssamtaler for alvorlig syke eldre. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Implementering av forhåndssamtaler for geriatriske pasienter - En klynge-randomisert studie i Helse Sør-Øst. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Presentasjon av faglige råd for forhåndssamtaler. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Opplæring helsepersonnel i forhåndssamtaler, sykehuset i Østfold, Kalnes. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Forhåndssamtaler for alvorlig syke hjemmeboende eldre. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Implementering av forhåndssamtaler for skrøpelige hjemmeboende eldre - foreløpige funn. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2022). Implementering av forhåndssamtaler for geriatriske pasienter: En klynge-randomisert studie i Helse Sør Øst. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2021). Presentasjon av ACP/NFR-prosjekt på geriatrisk avdeling, sykehuset i Vestfold (SiV). Fulltekst i vitenarkiv
• Westbye, Siri Færden (2021). Presentasjon av ACP/NFR-prosjekt på geriatrisk avdeling, Bærum sykehus. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2020). Aldersdiskriminering i koronaens tid. s. 1834–1835. doi: 10.4045/tidsskr.20.0783. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2020). Forhåndssamtaler for alvorlig syke hjemmeboende eldre. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2020). Forhåndssamtaler for alvorlig syke hjemmeboende eldre. Fulltekst i vitenarkiv
• Westbye, Siri Færden (2020). Forhåndssamtaler for alvorlig syke hjemmeboende eldre. Fulltekst i vitenarkiv

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