Background There are an increasing number of publications on ACP in NHs. However, few studies use mixed-methods design, few include all stakeholders as informants, and few describe the process of implementation and tools developed in detail.

Aim The aim of this abstract is to describe and discuss the design and methods of an on-going ACP-study in Norwegian NHs. It is the final part of the larger study «End-of-life Communication in Nursing Homes – Patient Preferences and Participation». The first two parts of the larger study were a systematic literature review, and a study of practice and experiences with ACP in NHs.

Methods This project has a mixed-methods design, using both quantitative (e.g. baseline registrations) and qualitative (e.g. interviews with all stakeholders, and logs from conversations) methods. 6 NHs were pair-matched, 1 of each pair randomised to systematic implementation of preparatory conversations.

Results/discussion One of the strengths of this study is the inclusion of all stakeholders, also patients without competence to consent and their next of kin. The main focus of this study is the process that ACP entails, and not how many advance directives filled in. This lack of standardisation may increase the possibility to elicit and listen to what is most important to patients when it comes to end of life care. However, the documented patient preferences with regard to future treatment will be less clear. Mixed methods give a more in-depth exploration of the complexities of reality. However, generating both quantitative and qualitative data is demanding, often limiting the size of the study.