Assessing the uptake of the Liverpool Care Pathway for dying patients: a systematic review

Abstract

Improving the care of the dying is regarded as a national priority and current guidelines stipulate the need to provide holistic palliative care. Despite this, many dying patients and carers report low levels of comfort and satisfaction with care. Reasons include poor coordination of care, variability in communication and crisis-driven interventions. Integrated care pathways aim to support care coordination and open communication with patients and carers. One example is the Liverpool Care Pathway (LCP). Using the LCP entails assessment of eligibility criteria which requires skills, knowledge and clinical judgement about its timing. This can be problematic, and little is known about actual uptake, characteristics of assessed patients and reasons for inclusion/exclusion. A comprehensive systematic review was conducted for papers published between January 1990 and July 2012 providing information on LCP uptake. 17 papers met inclusion criteria. A total of 18 052 patients were placed on the LCP, in a variety of inpatient and primary care settings, and cancer and non-cancer diagnoses. 47.4% of dying patients identified were placed on the LCP. Although the LCP is widely recommended, it is only used for around half of dying patients. Reasons may include lack of knowledge, high staff turnover and concerns about applicability particularly for unpredictable dying trajectories. The proportion of patients who meet the eligibility criteria and the reasons surrounding low uptake remain unclear. Research is urgently required to further quantify the variable use of the LCP, and to investigate whether alternative approaches should be developed for non-cancer groups.

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

“…The present review confirms findings from previously published review articles [ 33 – 38 ]. An updated version (09/2010 to 06/2013) [ 34 ] of a preceding Cochrane report (1950 to 09/2009) [ 33 ] described the effect of LCP on symptoms relief at the end-of-life when compared with usual care in hospitals, NHs, and at home.…”

Gaps in the Inpatient Management of Chronic Obstructive Pulmonary Disease Exacerbation and Impact of An Evidence-Based Order Set

“…Given this complexity, it would be challenging to integrate all features of a clinical pathway into a point-of-care CPOE system (45) to leverage this technology for broad implementation (as simple admission order sets can). These factors are likely why pathways have often shown poor uptake in actual practice (46). Our results suggest that similar benefits may be achievable with simple admission order sets.…”

Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end‐of‐life care

“…It was then introduced across UK clinical settings, including critical care units (Walker & Read , Parsons et al . , Stocker & Close ). Other developed countries followed suit, by implementing the LCP in their own health systems (Veerbeek et al .…”

“…The LCP was developed in 2002 as a clinical tool to improve care for dying patients and was indicated as a best practice initiative in the UK National End-of-life Care Strategy (DH 2008). It was then introduced across UK clinical settings, including critical care units (Walker & Read 2010, Parsons et al 2012, Stocker & Close 2013. Other developed Why this study is needed?…”