The Liverpool Care Pathway: discarded in cancer patients but good enough for dying nursing home patients? A systematic review

Abstract

BackgroundThe Liverpool Care Pathway (LCP) is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for dying people with dementia.MethodsThis systematic review is based on a systematic literature search of MEDLINE, CINAHL, EMBASE, and Web of Science.ResultsThe search identified 12 studies, but none describing an evidence-based adaption of LCP to nursing home patients and people with dementia. No studies described the LCP implementation procedure, including strategies for discontinuation of medications, procedures for nutrition and hydration, or the testing of such procedures in nursing homes. No effect studies addressing the assessment and treatment of pain and symptoms that include dying nursing home patients and people with dementia are available.ConclusionLCP has not been adapted to nursing home patients and people with dementia. Current evidence, i.e. studies investigating the validity and reliability in clinically relevant settings, is too limited for the LCP procedure to be recommended for the population at hand. There is a need to develop good practice in palliative medicine, Advance Care Planning, and disease-specific recommendations for people with dementia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-017-0205-x) contains supplementary material, which is available to authorized users.

Impact of the Liverpool Care Pathway on quality end‐of‐ care in residential care homes and home care—Nurses’ perceptions

“…As the LCP also includes recommendations for evidence‐based interventions to treat common symptoms such as pain, agitation, respiratory tract secretions, nausea/vomiting and dyspnoea, it was also seen as a tool for systematic alleviation of symptoms. Although surprisingly few studies examine the efficacy of the LCP about symptom relief (Chan & Webster, ; Husebø et al, ), our result is supported by a controlled before–after study by Brännström et al () who found symptom burden related to nausea and dyspnoea to be lower in RCHs using the LCP compared with those using standard care. In our study, ANs compared with RNs scored statistically significant higher about structured pain assessment and improvement of documentation of nursing interventions.…”

“…At the same time, both RNs and ANs reported that dialogues about patients’ imminent death had been facilitated. This finding sheds light on the complex and advanced task of caring for the dying and suggests that no pathway can replace competence in EoL care for achieving positive outcomes (Husebø et al, ). Patients and their families should be confident that, when facing a life‐threatening illness and in need of EoL care, they will receive high‐quality care according to their needs and preferences (Sandsdalen, Hov, Høye, Rystedt, & Wilde‐Larsson, ).…”

“…Not least, malpractice was evident in older, non‐cancer patients. The need for scientific evidence for the use of integrated care pathways, including the LCP, in EoL care is evident (Brännström et al, ; Chan & Webster, ; Husebø, Flo, & Engedal, ) as is the need for studies focusing quality care in a comprehensive way. This is especially true for the care of the dying in community care settings.…”

Social regulation activities in end-of-life: a qualitative study on completion of advance directives in Swiss nursing homes

“…The Liverpool Care Pathway (LCP) model in particular has generated extensive studies on the implementation and limits of ACP [10]. Sharp et al [11] have conducted a review of literature on the attitudes of the public and healthcare professionals towards ACP discussions with frail and older people.…”

Review article: End‐of‐life care for older people in the emergency department: A scoping review

“…Literature exists that outlines tools and guidelines to assist clinicians in the identification of people requiring EOL care . These tools and guidelines tend to inform care delivery of patients located in in‐patient settings and are not necessarily specific to older adults .…”