| Summary: | In Norway, nearly fifty percent of all deaths occur in nursing homes. The last period of life in other high-income countries is also increasingly spent in nursing homes. The nursing home doctor is responsible for medical care in the last phase of life. Together with nursing personnel, the nursing home doctor is expected to preserve patients’ dignity as they approach death. To achieve this the doctor needs to know something about what patients and their relatives need and expect, medical education must furnish doctors with the skills and tools to meet these expectations, and organisation of nursing home services must facilitate a dignity conserving care. In this dissertation I have explored conditions for doctors’ delivery of dignity conserving care to nursing home patients in the last period of life. My analysis is funded on three studies about the following topics: 1) What does previous research tell about patients’ and relatives’ expectations and experiences on how nursing home doctors can contribute to high quality end-of-life-care in nursing homes? 2) What are the learning experiences with end-of-life care in nursing homes for newly qualified doctors, especially concerning dialogues about death? and 3) Nursing home doctors’ perspectives on barriers and strategies for providing end-of-life care in nursing home in Norway and in the Netherlands. The first study was a metasynthesis of 14 qualitative studies about nursing home patients’ and relatives’ expectations and experiences with end-of-life care, with special focus on their perception of nursing home doctors’ work. We used the seven steps procedure for metaethnography from Noblit and Hare in our analysis. In the second study we used material from three focus group interviews with 16 newly qualified doctors serving as house officers in nursing homes in Northern Norway, exploring their learning experiences with end-of-life care in nursing home with special focus on dialogues about death. Analysis was performed with systematic text condensation, supported by ...
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