Background Nursing home (NH) patients have complex health problems, disabilities and social needs. COSMOS (COmmunication, Systematic pain assessment and treatment, Medication review, Occupational therapy, Safety) is a practical intervention aiming to test and implement evidence based practice. Advance Care Planning (ACP) by preparing communication with NH patients and relatives is a fundamental part of the COSMOS trial.

Aim Determine whether ACP improves communication process, ethical decision making and documentation, and reduce hospital admission and costs.

Methods COSMOS includes a 2-month pilot-study in nine Norwegian NHs (N = 128) and a 4-month multicenter, cluster randomised effectiveness-implementation clinical hybrid trial with follow-up at month 9, involving 520 patients from 64 NH units (one unit defined as one cluster). NHs are randomised to COSMOS intervention including a 3-day ACP education program with written guidelines, patient centred discussions and role play for staff, or current best practice (control group). Outcome measures: QoL (QUALIDEM, QUALID, EQ-5D), cost-utility analyses (RUD-FOCA), hospital admission and mortality.

Results Pilot study data demonstrate an increase in communication, decision making and documentation, and satisfaction among NH staff and relatives in the intervention compared to control groups. Impact of ACP on QoL, hospital admission, and nomination of legal guardians will be presented.

Discussion Considerable responsibility in care and treatment in NHs depends on commitment and capability of the system. Despite complex challenges, NH patients are often treated by staff with low skills, lack of education, and turnover.

Conclusion Implementation of ACP related research knowledge may improve QoL in NH patients and people with dementia.