Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Owen Doody, University of Limerick, Ireland
- Second opponent: Associate Professor Aud Elisabeth Witsø, NTNU: Norwegian University of Science and Technology
- Third member and chair of the evaluation committee: Professor Morten Ingvar Lossius, University of Oslo
Chair of the Defence
Professor Emeritus Erik Taubøll, University of Oslo
Principal Supervisor
Researcher Terje Nærland, University of Oslo
Summary
This doctoral thesis in the intersection between neurology, neurophysiology, medical ethics, and psychiatry investigates heart rate (HR) monitoring as a communicative aid for minimally communicative patients (MCPs). The work asks whether HR signals indexing patient reactivity can complement behavioural observation, and how wearable HR monitoring can be implemented ethically in routine care for this vulnerable group.
The thesis comprises four interrelated studies. Paper I is a real-world proof-of-concept pilot (n = 14) in residential care with continuous HR recording and caregiver annotation; HR “spikes” were defined as >1 SD above the daily mean lasting >5 s, annotations was aligned retrospectively. Paper II is a mixed-methods study of stakeholder perspectives (qualitative interviews n = 25; online survey n = 83) with thematic analysis and selected group comparisons. Paper III reports the development and psychometric validation of the Non-Verbal Patient–Caregiver Understanding Questionnaire (NPUQ; n = 219) using exploratory and confirmatory factor analysis and reliability indices (Cronbach’s α, McDonald’s ω). Paper IV is an ethical analysis of HR monitoring through medical ethics standards.
In the pilot, all but one participant had HR spikes judged meaningful by caregivers; in >75% of participants, increased HR was interpreted as pain or distress in situations not previously recognised, and HR data prompted care adjustments for eight patients. Most caregivers (78%) supported sensor-assisted communication. The NPUQ showed satisfactory internal consistency (α ≈ 0.74–0.79; ωt = 0.80, RMSEA = 0.07). The ethical analysis concluded that HR monitoring is ethically complex, but with appropriate safeguards, autonomy may be enabled rather than impeded.
Collectively, these studies offer an interdisciplinary, empirically grounded basis for controlled evaluation and ethically framed implementation of HR-based approaches to pain detection and care adaptation in MCPs.
Additional information
Contact the research support staff.