Here is the standardised PICO analysis for the twenty-sixth uploaded article:
Full Title
Implementing advance care planning in Swedish healthcare settings – a qualitative study of professionals’ experiences
Authors: Simon Beck, Lina Lundblad, Camilla Görås, Malin Eneslätt
Journal: Scandinavian Journal of Primary Health Care, 2023; 41(1):23–32
DOI: 10.1080/02813432.2022.2155456
Type of Study
Qualitative study (inductive design, group and individual interviews)
PICO Summary
Population (P)
- Registered healthcare professionals (nurses, physicians, managers) in nursing homes (NHs) in one region of northern Sweden
- Setting: Publicly funded Swedish NHs, with split care responsibilities (municipal nurses and regional GPs)
- Context: Region-wide policy memorandum for ACP introduced in 2020 without structured implementation strategy
Intervention (I)
- Top-down implementation of a routine for advance care planning (ACP) in nursing homes
- Guided by a written policy memorandum, the intervention involved:
- Mapping patient preferences on admission
- A follow-up structured ACP conversation (2–4 weeks post-admission)
- Documentation of decisions to limit treatment (DLTs)
- Annual review or update based on health changes
- No formalised training or facilitation was offered across the region
Comparison (C)
- No formal comparator group; insights emerged from participants across 10 NHs with varying uptake and fidelity to implementation
Outcomes (O)
Process outcomes (qualitative themes):
- Engagement in ACP conversations involved stages of:
- Preparing (timing and inclusion of family)
- Being (relational and empathetic presence)
- Talking (navigating sensitive topics)
- Deciding (shared but physician-led decisions)
- Sharing (documentation and communication of DLTs)
Implementation-related outcomes:
- Barriers:
- Lack of structured training and role clarity
- Varied local engagement and documentation systems
- Incompatibility between municipal and regional health records
- Physician time constraints; confusion around ACP aims
- Facilitators:
- ACP seen as useful and necessary
- Professionals called for designated facilitators
- Recognised value of standardisation, ongoing support, and joint training
Findings Summary
This is the first Swedish study examining ACP implementation from a multi-professional perspective within NHs. It found that top-down policy alone was insufficient for sustainable ACP implementation. While professionals valued ACP, inconsistent engagement, inadequate training, documentation issues, and lack of coordination across providers were key challenges. ACP conversations focused heavily on medical decisions (e.g. hospitalisation, resuscitation), with less attention to psychosocial preferences, highlighting a gap in person-centred care delivery.
The authors advocate for a system-level implementation strategy using frameworks like i-PARIHS, with trained facilitators, coordinated documentation systems, and integration of both medical and existential domains of care planning .
Life In The Slower Lane 
Leave a comment