The Liverpool Care Pathway (LCP) influencing the UK national agenda on care of the dying

Ellershaw, John; Murphy, Deborah

doi:10.12968/ijpn.2005.11.3.18032

Cited by 42 publications

(41 citation statements)

References 5 publications

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“…56 In end-of-life care, the Liverpool Care Pathway (LCP) extends good practice, based on hospice care, to other settings. 57 However, while the LCP takes a patient-focused approach that maximises quality of life and involves and supports carers, it is concerned with the last days before death. Greater attention to communication and work across settings is found in the Gold Standards Framework (GSF) for patients in the last months of life.…”

Section: Care Pathwaysmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

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BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Care Pathwaysmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

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“…It requires each GP practice to develop an accurate electronic register of patients through team discussion using an agreed palliative care code, emphasising the importance of early identification and registration of those with any life limiting illness. This enables registered patients to have access to a range of interventions such as advance care planning, anticipatory medication and the Liverpool Care Pathway for the dying patient (LCP) (11). In order to register patients, health care professionals use the 'surprise question' which aims to identify patients approaching the last year of their life (12).…”

Section: Introductionmentioning

confidence: 99%

Reducing inequalities in care for patients with non-malignant diseases: Insights from a realist evaluation of an integrated palliative care pathway

et al. 2016

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Background: The need for palliative care is growing internationally with an increasing prevalence of non-malignant diseases. The integrated care pathway was implemented in primary care by multidisciplinary teams from 2009 in a locality in the North East of England. Fourteen general practitioner practices provided data for the study. Aim: To find whether, how, and under what circumstances palliative care registrations are made for patients with non-malignant diseases in primary care. Design: General practitioner practice data were analysed statistically and qualitative data were collected from health care professionals and members of relevant organisations. Findings: A mixed-effects logistic model indicated a significant difference beyond the 0.1% level (p < 0.001) in registrations between the malignant and non-malignant groups in 2011, with an odds ratio of 0.09 (=exp(−2.4266)), indicating that patients in the non-malignant group are around 11 times (1/0.09) less likely to be registered than patients in the malignant group. However, patients with non-malignant diseases were significantly more likely to be registered in 2012 than in 2011 with an odds ratio of 1.46, significant beyond the 1% level. Qualitative analyses indicate that health care professionals find registering patients with non-malignant diseases stressful, yet feel that their confidence in treating this population is increasing. Conclusion: The integrated care pathway began to enable the reduction in inequalities in care by identifying, registering and managing an increasing number of palliative patients with non-malignant diseases. Consensual and inclusive definitions of palliative care were developed in order to legitimise the registration of such patients.

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“…This tool was developed in the U.K. originally, as a basis for end-of-life education for care providers and, more recently, has been used as a template to standardize how patients and their families are cared for at end of life, including how they experience the transitions between expert agencies. In a multicentred study of the effects of applying this clinical pathway, outcomes of improved symptom burden and documentation have been shown (Ellershaw & Murphy, 2005). It strikes me that this tool represents an extension of the evidence-based and structured approach to patient care that the expert cancer system has been shown to provide.…”

Section: Clinical Pathwaysmentioning

confidence: 99%

Helene Hudson AMGEN Lectureship 2010 Learning to be a dying person: Being outside/inside cancer treatment systems

Syme¹

2011

CONJ

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The woman who spoke these words has died of cancer. The day she said this she had just learned that the cancer she had was incurable. I open with this account to introduce the concern and focus of my study. This is what I call the 'liminal space'. Jane* came to this space after being through the cancer treatment system, learning what it was to be a person with cancer, learning how to be a cancer patient with colon cancer, learning that the chemotherapy, surgery and radiation therapy she had could not rid her of her cancer, and now being faced with learning to be a person who would die of cancer.Liminality is a concept arising out of anthropology, describing a betwixt and between place and persona between a past and future state (Turner, 1969;van Gennep, 1960). Meyers (2008) explores liminality through the lens of existential philosophers Sartre and Merleau-Ponty's reflections on being and nothingness. Liminality is also taken up in sociology in terms of inter-polar spaces between cultures (Fanetti, 2005) and in thinking about porches as thresholds and transitioning spaces (Walker, 2005). Liminality is also explored in health care literature relating to chronic illness (Frankenberg, 1986), and as a space experienced by people facing life-limiting diseases (Bruce et al., in press). Finally, liminality is explored for people with cancer in terms of a process (Little, Jordens, Paul, Montgomery, & Philipson, 1998) and as a life-long way of being after being diagnosed with cancer (Navon & Morag, 2004).This study explores liminality as a particular space that opens up for some people leaving cancer treatment centres and, being faced with dying because of their cancer, how they go on. As a concept liminality is rooted in the betwixt/between living/dying and expressed by people like Jane, as an ambiguous space and self. I will also demonstrate that, in some particular and observable ways, it is a space shaped by the cancer treatment system and how people are constituted and constitute themselves as cancer patients and, subsequently, as dying persons. This will be carefully explored, as liminality itself is a rather ineffable concept, particularly as this applies to a dying person, and difficult to expose in an empirical manner. However, liminality is also a space that lies between two expert systems, and is, therefore, shaped by and experienced through how these systems are and how these systems are taken up by people who find (or lose) themselves in a liminal space. Therefore, while liminality is not a new term to be used in cancer or other life-limiting diseases, the ways in which liminality is positioned in this study are new territory for cancer palliative care research and nursing.

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The Liverpool Care Pathway (LCP) influencing the UK national agenda on care of the dying

Cited by 42 publications

References 5 publications

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Reducing inequalities in care for patients with non-malignant diseases: Insights from a realist evaluation of an integrated palliative care pathway

Helene Hudson AMGEN Lectureship 2010 Learning to be a dying person: Being outside/inside cancer treatment systems

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