Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework

Abstract

BackgroundThe effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the UK hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards.MethodsWe conducted a phase 0–1 study according to the Medical Research Council Framework. Phase 0 consisted of a review of existing LCP programmes from the UK, Italy, and the Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, we developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. The care programme was reviewed and refined by two nurses and two physicians working in an acute geriatric ward and by two experts from Italy and the Netherlands.ResultsPhase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation and a summary of the LCP concerns raised in the UK. Based on these findings we developed a new care programme consisting of (1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward, (2) supportive documentation, and (3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.ConclusionsBased on the existing LCP programmes and taking into account the key factors for successful LCP implementation as well as the concerns raised in the UK, we developed a care programme for the last days of life and modelled it to the acute geriatric hospital wards after gaining feedback from health professionals caring for older hospitalized patients.

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

“…In total, we identified 12 studies investigating LCP use in NH patients and people with dementia. This also included one method paper which describes the development of a complex intervention [ 16 ]. The results are organized according to themes evident in the text and Tables 2 , 3 and 4 : i) Studies investigating the use of LCP in NHs and people with dementia, ii) Studies investigating the use of the GSFCH and LCP in NHs and people with dementia, and iii) Studies investigating the effect or further development of LCP in acute or general geriatric ward.…”

“…Very small numbers in sub-groups and not-randomized study design make interpretability of results questionable. Grading: 2b Verhofstede R, 2015 [ 16 ], Belgium Phase 0–1 methodology study based on Medical Research Council framework to develop and evaluate a complex intervention Phase 0 consists of a review of existing LCP programs from UK, Italy, and the Netherlands (NL), to identify factors for a successful LCP implementation and analysis of the concerns raised in the UK. Phase 1, is the development a care program for last days of life for older patients dying in AGW based on phase 0.…”

“…The second study, by Verhofstede et al, [ 16 ] took a methodological approach, which was described as two phase study: Phase 0 (preclinical phase) consisted of a non-systematic review to evaluate factors for successful LCP implementation in the UK, Italy, and NL. Based on the results, phase 1 (modelling phase) developed a Care Guide for the Last Days of Life, supportive documentation, and an implementation guide addressing the older acute geriatric hospital population.…”

“…Relevant to research question 2, our systematic search identified two before–after intervention studies [ 17 – 19 , 26 ], two retrospective surveys [ 21 , 22 ], two qualitative studies [ 23 – 25 ], two mixed-method studies [ 12 , 20 ], and one methodology study [ 16 ]. There were no randomized controlled trials (RCT) or prospective studies on LCP use in NHs or people with dementia.…”

“…Also, the article by Watson et al [ 12 ] deserves attention because it describes the bottlenecks of LCP implementation and use in these settings and addresses potential problems in adopting it in NHs and to persons with dementia 2006. A more recent article highlights the further development of the LCP to meet the patients’ needs when they are at the end-of-life admitted to an acute geriatric ward or general geriatric ward [ 16 , 26 ]. This contribution outlines a stepwise, review process and plans to adapt LCP for care for the elderly.…”