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ArticleEuropean geriatric medicine2026

Ethical challenges in acute geriatric care and advance care planning: a nested qualitative study.

Karin Berg Hermansen, Trygve Johannes Lereim Sævareid, Reidar Pedersen, Rigmor Einang Alnes, Linn Brøderud, Maria Romøren, May Helen Midtbust

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In one paragraph

Article in European geriatric medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05681585 (Implementing Advanced Care Planning in the Routine Care for Acutely Admitted Patients in Geriatric Units), which is not on this map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05681585 narecruitingnot on this map

Implementing Advanced Care Planning in the Routine Care for Acutely Admitted Patients in Geriatric Units: a Cluster Randomised Controlled Trial

TypeinterventionalSponsorUniversity of OsloRan2023 to 2026Enrolled2,000ConditionsAdvance Care PlanningArmsImplementation support program
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Karin Berg HermansenDepartment of Health Sciences, Aalesund Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 1517, 6025, Aalesund, Norway. karin.hermansen@ntnu.no.ORCID http://orcid.org/0009-0001-4927-2926
Trygve Johannes Lereim SævareidCentre for Medical Ethics, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway.ORCID http://orcid.org/0000-0001-9062-7787
Reidar PedersenCentre for Medical Ethics, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway.
Rigmor Einang AlnesDepartment of Health Sciences, Aalesund Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 1517, 6025, Aalesund, Norway.
Linn BrøderudCentre for Medical Ethics, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway.
Maria RomørenCentre for Medical Ethics, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway.
May Helen MidtbustDepartment of Health Sciences, Aalesund Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 1517, 6025, Aalesund, Norway.ORCID http://orcid.org/0000-0002-7007-6663

Funding

Norges Forskningsråd 302880
6 · The paper itself

Abstract

purposeEthical challenges are common in geriatrics, and moral dilemmas and conflicting interests can arise in advance care planning (ACP). Respecting the wishes of frail, acutely ill older patients while acting in their best interests can be challenging. This study was nested within a cluster randomized controlled trial aimed at implementing ACP in acute geriatric hospital units. The aim of this study was to explore clinicians' experiences of ethical challenges in geriatric units before and during this implementation project.

methodsEight semi-structured interviews-four focus groups and four dyadic interviews-were conducted with a total of twenty-four participants, including implementation teams and other clinicians from the six intervention units. These participants had engaged in ACP with frail, acutely ill older patients and, preferably, their next of kin. The data were analyzed using Braun and Clarke's reflexive thematic analysis.

resultsFour themes were developed: (1) navigating prognostic uncertainty while sustaining hope, (2) providing information that enables understanding and participation, (3) managing family disagreements and emotional strain, and (4) preserving dignity towards the end of life. The findings indicate that ethical challenges were often mitigated rather than intensified through ACP conversations.

conclusionEthical challenges in acute geriatric care arose when patient autonomy was limited by cognitive impairment, unclear preferences, or family disagreement. Earlier preparation of patients and next of kin through ACP could facilitate early identification of potential disagreements and provide a stronger foundation for dialogue in acute situations.

trial registrationClinicalTrials.gov Identifier: NCT05681585. Registered 03.01.23.

Indexed as

Advance care planningEthicsHealth personnelHospitalOlder patientsQualitative

Identifiers

PMID42521921

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.