{"title":"Death awaits.","authors":"Pål Gulbrandsen","doi":"10.4045/tidsskr.24.0535","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0535","url":null,"abstract":"","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"En klatt her og en klatt der.","authors":"Are Brean","doi":"10.4045/tidsskr.24.13.01","DOIUrl":"https://doi.org/10.4045/tidsskr.24.13.01","url":null,"abstract":"","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The pesky issue of consent.","authors":"Øyvind Stople Sivertsen","doi":"10.4045/tidsskr.24.0553","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0553","url":null,"abstract":"","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fredrik Brunsvig-Engemoen, Maria Romøren, Holgeir Skjeie
{"title":"Conversations with patients about death - experienced GPs' reflections and experiences.","authors":"Fredrik Brunsvig-Engemoen, Maria Romøren, Holgeir Skjeie","doi":"10.4045/tidsskr.24.0093","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0093","url":null,"abstract":"<p><strong>Background: </strong>The ageing population in Norway is steadily increasing, and both the number and complexity of patient-related tasks assigned to the primary health service, including GPs, are growing. This study aimed to investigate how experienced GPs conducted and reflected on conversations with their patients about death.</p><p><strong>Material and method: </strong>Semi-structured in-depth interviews with ten experienced GPs, all specialists in general practice, were analysed using cross-case thematic analysis.</p><p><strong>Results: </strong>Almost all the GPs viewed talking about death with their patients as a natural part of a GP's duties. The conversations were perceived as both challenging and meaningful. Having sufficient time for the conversation and getting to know the patients over time were considered valuable factors for good conversations. The GPs looked for golden moments in which to address the topic. The content of the conversation could vary, from specific measures to alleviate symptoms to the more existential and philosophical. The GPs expressed that they lacked formal competence and largely relied on their experience and belief in their communication skills when interacting with patients. Several described the lack of clarity on treatment intensity from the specialist health service as a barrier to initiating and conducting good conversations about death.</p><p><strong>Interpretation: </strong>Most of the GPs in this study talked to their patients about death and considered it a natural and necessary part of the GP's role.</p>","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Om forhåndssamtaler, retningslinjer og randomisering.","authors":"Mette Kalager","doi":"10.4045/tidsskr.24.0539","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0539","url":null,"abstract":"","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hege Ihle-Hansen, Håkon Ihle-Hansen, Siri Rostoft, John Munkhaugen, Siri Ferden Westbye, Maria Romøren, Trygve Johannes Lereim Sævareid, Linn Brøderud, Karin Berg Hermansen, Marie Hamilton Larsen, Astrid Klopstad Wahl, Marc Ahmed, Reidar Pedersen
{"title":"Advance care planning towards the end of life.","authors":"Hege Ihle-Hansen, Håkon Ihle-Hansen, Siri Rostoft, John Munkhaugen, Siri Ferden Westbye, Maria Romøren, Trygve Johannes Lereim Sævareid, Linn Brøderud, Karin Berg Hermansen, Marie Hamilton Larsen, Astrid Klopstad Wahl, Marc Ahmed, Reidar Pedersen","doi":"10.4045/tidsskr.24.0105","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0105","url":null,"abstract":"<p><strong>Background: </strong>New national clinical guidelines are now available on advance care planning (ACP). Confidence in communication is important for implementation of the guidelines. This study aims to identify healthcare personnel's self-perceived confidence in communication about future medical care and patients' wishes at the end of life.</p><p><strong>Material and method: </strong>Healthcare personnel in twelve geriatric units in South-Eastern Norway Regional Health Authority responded to an online questionnaire survey in autumn 2022. The four response alternatives for self-reported confidence - 'unconfident', 'fairly confident', 'very confident' and 'extremely confident'- are combined into two categories: 'limited confidence' ('unconfident' and 'fairly confident') and 'high confidence' ('very confident' and 'extremely confident').</p><p><strong>Results: </strong>We received responses from 289 of the 470 (61.5 %) invited, with an average age of 37.8 ± 11.3 years, of whom 217 out of 289 (75 %) had more than five years of professional experience. Of the doctors, 15 out of 67 (22 %) reported limited confidence in communication about 'future deterioration of the patient's health condition', 20 out of 67 (30 %) about 'life-sustaining treatment' and 13 out of 67 (19 %) about 'preferences towards the end of life'. For other healthcare personnel, the corresponding responses were 119 out of 222 (54 %), 140 out of 222 (63 %) and 109 out of 222 (49 %).</p><p><strong>Interpretation: </strong>Self-assessed confidence in communication about future deterioration, future medical care and the patient's own wishes at the end of life varies, and such confidence is limited among many health personnel in geriatric units. Measures appear to be needed to increase confidence in the communication and implementation of ACP in the Norwegian health service.</p>","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trakeobronkomalasi hos barn.","authors":"Sofie Vaula, Knut Øymar, Vegard Hovland, Iren Lindbak Matthews, Christine Sachs-Strømmen, Håvard Ove Skjerven, Suzanne Crowley, Ingvild Bruun Mikalsen","doi":"10.4045/tidsskr.24.0116","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0116","url":null,"abstract":"<p><p>This clinical review article aims to describe symptoms and findings in cases of paediatric tracheobronchomalacia to help achieve the correct diagnosis and treatment. Symptoms and signs vary from reduced physical stamina, barking cough, productive cough and gurgling to obstructive episodes or episodes with stridor, which in some cases can be life-threatening. The range of symptoms overlaps with other pulmonary diseases, such as asthma, which increases the risk of misdiagnosis and treatment error. Bronchoscopy is the main diagnostic tool but is resource intensive.</p>","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Margrethe Aase Schaufel, Reidun Førde, Katrin Ruth Sigurdardottir, Ingrid Miljeteig
{"title":"Pulmonologists' experiences with palliative sedation for terminally ill patients.","authors":"Margrethe Aase Schaufel, Reidun Førde, Katrin Ruth Sigurdardottir, Ingrid Miljeteig","doi":"10.4045/tidsskr.23.0778","DOIUrl":"https://doi.org/10.4045/tidsskr.23.0778","url":null,"abstract":"<p><strong>Bakgrunn: </strong>Legeforeningen har utarbeidd retningslinjer for lindrande sedering i livets sluttfase, sist revidert i 2014. Vi ville undersøke lungelegar sin kjennskap til retningslinjene og bruk av lindrande sedering ved lungesjukdomar.</p><p><strong>Materiale og metode: </strong>Eit elektronisk spørjeskjema blei sendt til alle medlemmer av Norsk forening for lungemedisin (529 legar) i oktober 2022. Svara blei analysert med deskriptiv statistikk, og fritekstkommentarane blei analysert ved systematisk tekstkondensering.</p><p><strong>Resultat: </strong>Totalt 50 legar svarte (9,5 %). 22 hadde kjennskap til retningslinjene, og eit mindretal meinte desse var tydelege og gav god støtte. 37 oppgav at lindrande sedering blei gjennomført der dei jobba, men det var stor variasjon i kor ofte. 25 av deltakarane hadde vore med på å gjennomføre lindrande sedering ein eller fleire gonger, og 19 hadde opplevd etiske utfordringar relatert til dette. Sederinga vart oftast utført hjå pasientar med lungekreft ved intraktabel dyspné og smerter, men også hjå andre sjukdomsgrupper. Avgjerda vart stort sett tatt i tverrfagleg fellesskap, og fritekstkommentarane utdjupa at dette gav støtte og tryggleik. Det vart påpeikt ein krevjande grenseoppgang mot dødshjelp, og ønskje om at gråsonene kunne utdjupast meir i retningslinjene.</p><p><strong>Tolking: </strong>Definisjonen av lindrande sedering blir framleis oppfatta ulikt og kan framstå uklar. Det kan moglegvis vere til hjelp å legge til diagnosespesifikke råd ved revisjon av gjeldande retningslinjer.</p>","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethically challenging end-of-life situations.","authors":"Anne Fasting","doi":"10.4045/tidsskr.24.0533","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0533","url":null,"abstract":"","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Kort avstand mellom svangerskapene kan være bra.","authors":"Anne Eskild","doi":"10.4045/tidsskr.24.0460","DOIUrl":"https://doi.org/10.4045/tidsskr.24.0460","url":null,"abstract":"","PeriodicalId":23123,"journal":{"name":"Tidsskrift for Den Norske Laegeforening","volume":"144 13","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}