The Liverpool care pathway: a cautionary tale

Sleeman, Katherine E; Collis, Emily

doi:10.1136/bmj.f4779

Cited by 24 publications

(25 citation statements)

References 1 publication

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“…They reinforce Sleeman and Collis's6 identification of the need for a stronger evidence base for end-of-life care tools to avoid making the same mistakes again and also highlight the pitfalls to avoid when implementing end-of-life care guidance. As such, our study will be of interest not only to those seeking to understand the weaknesses of the LCP but also to those charged with introducing similar processes in the same contexts.…”

Section: Discussionsupporting

confidence: 52%

“…Based on that report, the LCP has been replaced in England by individualised end-of-life care planning. Even so, simply withdrawing the LCP and replacing it with an end-of-life care plan and condition-specific guidance—a recipe that has not been prospectively evaluated—will not necessarily improve end-of-life care 6. There remains a need for a stronger evidence base for the components as well as the implementation of end-of-life care planning 7.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: a realist evaluation

McConnell

O’Halloran

Donnelly³

et al. 2014

BMJ Support Palliat Care

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ObjectivesThe Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation.MethodAn organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semistructured interviews were conducted with two policymakers and 22 participants with experience and/or involvement in management of the LCP during 2011 and 2012.ResultsKey resource inputs included facilitation with a view to maintaining LCP ‘visibility’, reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy, and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care.ConclusionsThere is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: a realist evaluation

McConnell

O’Halloran

Donnelly³

et al. 2014

BMJ Support Palliat Care

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“…Moreover, a sustained change in behaviour is only the first step in supporting the recommendation of a protocol such as SPIKES. Success that is measured purely against adherence to a pre-set process is effectively self-referential; the altered professional behaviour should also be demonstrated to improve patient experience, a challenge facing palliative care research more generally (Sleeman and Collis, 2013).…”

mentioning

confidence: 99%

The use of protocol in breaking bad news: evidence and ethos

Dean¹,

Willis

2016

Int J Palliat Nurs

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This article discusses health professional use of protocol in the breaking of bad news, focussing particularly on the well-known SPIKES framework. The evidence of impact on the patient experience is examined and recommendations are made for further outcome-based research. Existing evidence suggests that the model as commonly interpreted may not fully meet the needs of patients or reflect the clinical experience of breaking bad news for some professionals and further guidance may be needed to support them in their practice. The ethos of the step-wise protocol is debated, questioning whether it helps or hinders individualised care and the formation of a genuine relationship between patient and professional. Finally recommendations for practice are offered.

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“…5 In response, the National Institute for Health Research (UK) has commissioned a mapping of evidence requirements in palliative and end-of-life care. The James Lind Alliance Priority Setting Partnership has also been established to find out what palliative and end-of-life care research is important to people who are likely to be within the last years of life, and their families and carers, to inform the future research.…”

Section: Increasing the Value Of Research In Palliative Carementioning

confidence: 99%