This study revealed an overall positive picture of personal and nursing care and communication. These findings indicate that the quality of EOL care at RCHs is high. Inadequate management was found for symptom relief the last days of life. This suggests that this subject merits further attention by care professionals. To achieve better quality of EOL care at RCHs, we emphasise the importance of systematically working to improve symptom relief.

The results of this study indicate that the LCP might be a useful tool for care professionals in improving end-of-life care in RCHs through increased attention to the goals of care, the individual needs of residents and family involvement.

Background: Social skills group training is an intervention method that has demonstrated moderate evidence of improvement among children and adolescents with autism spectrum disorder (ASD). KONTAKT is a manualized social skills group training program that was developed in Germany and that has demonstrated preliminary evidence of positive effect. In this study, we describe its adaptation to Scandinavian settings. Objective: The aim of this study was to evaluate the clinical feasibility of the Swedish version of KONTAKT. The program was piloted in two outpatient departments in Stockholm County. Method: A convergent mixed-method approach that involved both quantitative (ratings scales for ASD, clinical severity, and adaptive functioning) and qualitative (semi-structured interviewing) evaluation was applied. Twenty-two children and adolescents with high-functioning ASD between the ages of 8 and 17 years and their parents were enrolled in a one-group trial and completed assessments before and after KONTAKT training. Results: The quantitative evaluation showed improvements in social communication and global everyday functioning; the qualitative evaluations yielded general treatment satisfaction. Twenty of the 22 enrolled adolescents (91%) completed the training. Conclusions: These findings suggest that the Swedish adaptation of KONTAKT is feasible for Scandinavian clinical settings. It is currently being examined for efficacy and effectiveness in the largest multicenter randomized controlled trial of social skills group training in patients with ASD that has ever been undertaken (NCT01854346).

Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.

Background The Serious Illness Care Program (SICP) is a model developed for structured communication, identifying patients, and training physicians to use a structured guide for conversations with patients and family members. However, there is a lack of knowledge regarding the sustainable implementation of this conversation model. Therefore, the aim of this study was to identify barriers and enablers during the implementation of the SICP in hospital settings. Methods The SICP was implemented at 20 units in two hospitals in Sweden. During the implementation process, seven individual interviews and two group interviews were conducted with seven facilitators (five physicians, one behavioral therapist, and one administrator). Data were analyzed using qualitative content analysis, first inductively, and then deductively using the organizational readiness for change as a theoretical framework. Result The analysis resulted in three factors acting as enablers and eight factors acting as enablers and/or barriers during the implementation of the SICP. The three factors considered as enablers were preliminaries, identifying patients, and facilitator’s role. The eight factors considered as enablers and/or barriers were broad implementation, leadership, time, confidence, building foundation, motivation to work change, motivation for training in serious illness conversations, and attitudes. Conclusion This study indicates limited readiness to implement the SICP in hospital settings due to considerable variation in organizational contextual factors, change efficacy, and change commitment. The identified enablers and barriers for implementation of the SICP could guide and support future implementations to be sustainable over time.