Improving comfort around dying in elderly people: a cluster randomised controlled trial

Beernaert, Kim; Smets, Tinne; Cohen, Joachim; Verhofstede, Rebecca; Costantini, Massimo; Eecloo, Kim; Noortgate, Nele Van Den; Deliëns, Luc

doi:10.1016/s0140-6736(17)31265-5

Cited by 27 publications

(62 citation statements)

References 25 publications

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“…Moreover, Mackintosh 90 has argued that the calls for better evidence in the LCP debate are misplaced ‘….since what is being measured is not the performance of the tool but the performance of the user’ (p651) . The RCT evidence that has since emerged from Italy 120 and from the Netherlands 113 powerfully draws attention to this point.…”

Section: Discussionmentioning

confidence: 99%

“…The ‘take home’ message from the cluster trial was that any benefit derived from the LCP depends on the quality of its implementation. Since then, a cluster randomized trial of the ‘Care Programme in the Last Days of Life’ (CAREFul) has been conducted in the Netherlands, based on the LCP and taking account of its critique 113 , finding that the progamme improved nurse assessed comfort but not satisfaction with care among relatives. The authors conclude that further qualitative research is required to gain an understanding of this apparent discrepancy and recommend ‘controlled implementation’ with due regard for ongoing training of clinicians especially in communication skills 113 (p132).…”

Section: Aftermathmentioning

confidence: 99%

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The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

Seymour

Clark

2018

Wellcome Open Res

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Background: The Liverpool Care Pathway for the Dying Patient (‘LCP’) was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review. Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice? 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the ‘boundary object’ concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Aftermathmentioning

confidence: 99%

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

Seymour

Clark

2018

Wellcome Open Res

View full text Add to dashboard Cite

show abstract

“…Moreover, Mackintosh 88 has argued that the calls for better evidence in the LCP debate are misplaced ‘….since what is being measured is not the performance of the tool but the performance of the user’ (p651) . The RCT evidence that has since emerged from Italy 118 and from the Netherlands 111 powerfully draws attention to this point.…”

Section: Discussionmentioning

confidence: 99%

“…The ‘take home’ message from the cluster trial was that any benefit derived from the LCP depends on the quality of its implementation. Since then, a cluster randomized trial of the ‘Care Programme in the Last Days of Life’ (CAREFul) has been conducted in the Netherlands, based on the LCP and taking account of its critique 111 , finding that the progamme improved nurse assessed comfort but not satisfaction with care among relatives. The authors conclude that further qualitative research is required to gain an understanding of this apparent discrepancy and recommend ‘controlled implementation’ with due regard for ongoing training of clinicians especially in communication skills 111 (p132).…”

Section: Aftermathmentioning

confidence: 99%

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

Seymour¹,

Clark²

2018

Wellcome Open Res

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Background : The Liverpool Care Pathway for the Dying Patient (‘the LCP’) was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review. The ensuing debate among clinicians polarised between ‘blaming’ of the LCP and regret at its removal. Employing the concept of ‘boundary objects’, we aimed to address three questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods : We use primary and secondary sources in the public domain to assemble a critical and historical review. Results : The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. The subsequent LCP ‘scandal’ demonstrated the power of social media in creating knowledge, as well as conflicting perceptions about end-of-life interventions. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. This was beyond its original remit. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions : In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.

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“…Optimal palliative care is a paramount issue for older adults with advanced cancer. There were three trials that addressed issues of palliative and supportive care in older patients last year 15 – 17 . In the first study 15 , the effect of antipsychotics in “terminal delirium” among palliative care patients was explored.…”

Section: Advancements In Palliative and Supportive Carementioning

confidence: 99%

Recent advances in non-surgical management of cancer in the elderly

et al. 2018

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This article summarizes the seminal publications from mid-2016 through 2017 in the area of medical care for older adults with cancer. Areas addressed include chemotherapy tolerance and efficacy in the aged, geriatric fitness assessments, and advancements in palliative and supportive care. The practice-changing finding from this past year’s publications is that antipsychotics should not be used in the management of terminal delirium in older adults receiving palliative care. The other trials demonstrated an improved understanding of the utility of geriatric assessments in patients with cancer, developed the body of information about which chemotherapy agents are safe and effective in older adults (and which are not), and expanded our understanding of good palliative and supportive care.

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Improving comfort around dying in elderly people: a cluster randomised controlled trial

Cited by 27 publications

References 25 publications

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

Recent advances in non-surgical management of cancer in the elderly

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