End-of-Life Decision Making for Cancer Patients in Different Clinical Settings and the Impact of the LCP

Abstract

Differences in the general focus of care among hospitals, nursing homes, and homes may affect the adequacy of end-of-life decision making for the dying. We studied end-of-life decision-making practices for cancer patients who died in each of these settings and assessed the impact of the Liverpool Care Pathway for the Dying Patient (LCP), a template for care in the dying phase. Physicians and relatives of 311 deceased cancer patients completed questionnaires. The LCP was introduced halfway through the study period. During the last three months of life, patients who died in hospital received anticancer therapy and medication to relieve symptoms more often than those in both other settings. During the last three days of life, patients who died in the hospital or nursing home received more medication than those who died at home. The LCP reduced the extent to which physicians used medication that might have hastened death. Relatives of patients who died in the hospital tended to be least positive about the patient's and their own participation in the decision making. We conclude that cancer patients who die in the hospital are more intensively treated during the last phase of life than those who die elsewhere. The LCP has an impact on the use of potentially life-shortening medication during the dying phase. Communication about medical decision making tends to be better in the nursing home and at home.

Dying at home – is it better: A narrative appraisal of the state of the science

“…Seven more recent studies showed inconsistencies in what was considered a 'home death', in the measurement of pain and in the groups compared. 50,[54][55][56][57][58][59][60] This highlights the need for greater clarity and consistency in measurement and patient selection.…”

Staff Perceptions of End-of-Life Care following Implementation of the Liverpool Care Pathway for the Dying Patient in the Acute Care Setting: A New Zealand Perspective

“…12 The LCP is structured around an initial assessment, ongoing care, and care after death. Positive outcomes regarding integrated care pathways (ICP) for EOL care in various settings have been identified 8,[13][14][15][16][17][18][19] although randomized control trials are absent. 13,20 The LCP has been found to improve the plan of care, provide guidance, and improve documentation and communication.…”

Continuity, Coordination, and Transitions of Care for Patients with Serious and Advanced Illness: A Systematic Review of Interventions

“…23,32,34,37 Two (50%) reported significant results in favor of the intervention. 32 Four studies reported on do-not-resuscitate and advanced directive status 15,26,35,38 as an outcome of the intervention. Two were RCTs.…”