The Liverpool Care Pathway: its impact on improving the care of the dying

Shah, Sanjay

doi:10.1093/ageing/afi040

Cited by 8 publications

(12 citation statements)

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“…Today end-of-life pathways are used widely: in UK and Europe as LCP; and Palliative Care for Advanced Disease in the USA (Bookbinder et al, 2005;Luhr et al, 2005). However, as the studies on the use of these integrated care pathways are descriptive, and randomized studies are not practical, their benefi t has been criticized (Shah, 2005). The continuous sedation used in the protocol also raised concern (Murray, 2008;Treloar, 2008).…”

Section: Discussionmentioning

confidence: 99%

The implementation of an end-of-life integrated care pathway in a Chinese population

Chan

et al. 2009

Int J Palliat Nurs

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The integrated care pathway is used in end-of-life care to improve quality of care; the Liverpool Care Pathway (LCP) has been used in Europe and North America. Tuen Mun Hospital is a regional hospital in Hong Kong, China. The End-of-life Care Pathway (ECP) based on the concepts used in the Liverpool Care Pathway, was developed, with modification to suit the local condition. Criteria for entry onto the ECP were that the multidisciplinary team agreed the patient was dying, and was at least two of the following: bedbound; semi-comatose; only able to take sips of fluid; no longer able to take tablets. The ECP template replaced all other inpatient documents. The ECP was implemented in the palliative care unit for terminal cancer patients. An audit was performed to review the result. Fifty-one Chinese patients were included in the audit with mean age 64. The median duration of ECP use was 24 hours. All patients had current medication assessed and non-essential drugs were discontinued. The audit result suggested integrated care pathway in end-of-life care could be implemented successfully in an Oriental culture. The acceptance of using the ECP as a standard clinical practice takes time and education. Appropriate template design and supervision are the keys to success.

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Section: Discussionmentioning

confidence: 99%

The implementation of an end-of-life integrated care pathway in a Chinese population

Chan

et al. 2009

Int J Palliat Nurs

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“…To date, there has been little literature concerning the needs of dying patients after stroke and those close to them (Jack et al 2004, Shah et al 2005, Stevens et al 2007). However, we do know that during the last days of lives their care needs are likely to be similar to those of people dying from other conditions (Addington-Hall 2005, Ellershaw 2007, Mirando et al 2005.…”

Section: Stroke Care At the End Of Lifementioning

confidence: 99%

Experiences of hospital care reported by bereaved relatives of patients after a stroke: a retrospective survey using the VOICES questionnaire

Young

Rogers

Dent

et al. 2009

Journal of Advanced Nursing

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Experiences of hospital care reported by bereaved relatives of patients after a stroke: a retrospective survey using the VOICES questionnaire. Journal of Advanced Nursing 65(10), 2161-2174. doi: 10.1111/j.1365-2648.2009.05081.x Abstract Title. Experiences of hospital care reported by bereaved relatives of patients after a stroke: a retrospective survey using the VOICES questionnaire. Aim. This paper is a report of a study conducted to explore the determinants of satisfaction with health and social care services in the last 3 months and 3 days of life as reported by bereaved relatives of those who died from a stroke in an institutional setting. Background. There is limited research about how best to meet the needs of those who die from stroke. A thorough understanding of the determinants of satisfaction with end of life care is crucial for effective service provision to increase awareness of the needs of dying patients. Methods. During a six-month period in 2003, a population-based survey of bereaved relatives of patients after stroke was conducted using a stroke-specific version of the Views of Informal Carers Evaluation of Services postal questionnaire (183 informants, response rate 37%). The sub-sample included those informants who reported that the deceased person had died in an institutional setting (91%, n = 165). The analysis was divided into two phases: univariate (Pearson chi-square test) and multivariate phase (logistic regression). Results. Logistic regressions showed that discussing any worries about the treatment of the deceased person and feeling that the doctors and nurses knew enough about their condition were predictors of satisfaction with doctors and nurses in the last 3 months of life. Meeting the personal care needs of the deceased person, being involved in decisions and feeling that the deceased person died in the right place were predictors of satisfaction with care in the last 3 days of life. Conclusion. End of life care needs to address the individual needs of patients who die from stroke and those close to them. This study shows that individualised end of life care increases satisfaction and, although the data reported in this paper reflect care in 2003, there is no more recent evidence that contradicts this important overall finding.

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“…The critique missed an important nuance: the LCP was styled quite explicitly as a quality improvement programme; something not usually associated with the more formalised approach of the RCT. This type of criticism was voiced openly in 2005, with publication of a letter in the journal Age and Ageing by a hospice doctor from Kent, Shah 55 , lamenting the absence of large scale RCT data to support the LCP. Shah was writing in response to an earlier research letter published in 2004 by Ellershaw’s team 56 that reported descriptive data on use of the LCP on an acute stroke unit from a ‘before and after’ study of 20 clinical cases, which showed:…”

Section: Translationmentioning

confidence: 99%

“…If we miss this opportunity, we will end up with an untested LCP accepted as a gold standard everywhere. We will then be unable to test its efficacy, as ethical approval will almost be impossible 55 (p197-8).…”

Section: Translationmentioning

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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The Liverpool Care Pathway: its impact on improving the care of the dying

Cited by 8 publications

References 0 publications

The implementation of an end-of-life integrated care pathway in a Chinese population

The implementation of an end-of-life integrated care pathway in a Chinese population

Experiences of hospital care reported by bereaved relatives of patients after a stroke: a retrospective survey using the VOICES questionnaire

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

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