title: How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway.
abstract: BACKGROUND
  Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors' descriptions of how they include the patient and next of kin in end-of-life decisions.
  
  
  METHODS
  We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation.
  
  
  RESULTS
  The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient's best interest.
  
  
  CONCLUSIONS
  Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient's values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.
authors.affiliation: Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O box 1130, Blindern, 0318, Oslo, Norway. maria.romoren@medisin.uio.no.
authors.forename: Maria
authors.initials: M
authors.lastname: Romøren
authors.affiliation: Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O box 1130, Blindern, 0318, Oslo, Norway. reidar.pedersen@medisin.uio.no.
authors.forename: Reidar
authors.initials: R
authors.lastname: Pedersen
authors.affiliation: Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O box 1130, Blindern, 0318, Oslo, Norway. reidun.forde@medisin.uio.no.
authors.forename: Reidun
authors.initials: R
authors.lastname: Førde
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D034462:Dissent and Disputes; D004992:Ethics, Medical; D005190:Family; D005260:Female; D017144:Focus Groups; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D009664:Norway; D009735:Nursing Homes / Q000941:ethics; D028701:Patient Rights; D010817:Physician-Patient Relations; D010820:Physicians / Q000941:ethics; D011368:Professional-Family Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000941:ethics; D055815:Young Adult