The Liverpool Care Pathway for the dying: what went wrong?

In defence of the ‘tick-box approach’: why end-of-life care is no exception

“…6 While the recommendations of each of these documents are all laudable, they have all arguably still failed to demonstrate that the LCP was the root cause of the problem. As inferred in a previous editorial, 7 although the LCP may have fallen into irredeemable disrepute, the concerns highlighted in the media and the subsequent Neuberger Review seemed more related to the general crisis in care culture in the NHS, than to any intrinsic problem with the LCP. Indeed, despite Neuberger noting an overall lack of high quality evidence, 4 further favourable research has since emerged: a recently published controlled before-and-after study in Sweden demonstrated a significant reduction in both shortness of breath and nausea in patients on the LCP compared with controls, concluding that 'When implemented with adequate staff training and support, the [LCP] may be a useful tool for providing end-of-life care of elderly people at the end of life in non-cancer settings'.…”

Omsorg ved livets slutt - En kvalitativ studie av sykepleieres erfaringer med bruk av Liverpool Care Pathway i sykehjem

“…LCP har siden blitt tatt i bruk i mer enn 20 land (Ellershaw et al, 2013) LCP har fått mye kritikk (Knights, Wood, & Barclay, 2013), og dette har også medført at den ble utfaset i Storbritannia. Land utenfor Storbritannia har imidlertid valgt å fortsette med bruken av LCP (Chan, Webster & Bowers, 2016).…”

“…LCP ble opprinnelig utviklet for bruk til kreftpasienter (Ellershaw et al, 1997), og det har vaert diskutert hvorvidt planen er egnet for andre pasientgrupper (Knights et al, 2013). I Storbritannia ble anbefalingen om å bruke LCP fjernet fra retningslinjene for omsorg til døende pasienter med demens (NICE, 2014).…”

The Government's progress in promoting choice in end-of-life care

“…There were many who advocated the LCP and, in a study of its use in clinical practice, Veerbeek et al (2008) found that the pathway contributed to the quality of documentation and symptom control in the care of dying patients .There is no doubt that the use of the LCP provided a framework for non-palliative care specialist clinicians including nurses to deliver highquality end-of-life care in many different clinical domains. Despite this, Knights et al (2013) showed that the LCP had come under too much intense media scrutiny, with some popular newspapers describing it as 'a pathway to euthanasia' which compromised patient autonomy, and was used to free up beds. Although there were many supporters of the LCP who continued use it in clinical practice, the pathway fell into disrepute and further adverse newspaper headlines demonised its use after families complained that their relatives had been put on the LCP pathway without their consent, and that death KEY POINTS ■ A publication from the Government, One Year On, aims to show progress in ensuring that every person who is approaching life's closure has equity of access to the support they and their families need ■ The challenge of delivering consistently good experiences for people at the end of their lives is growing with around 480 000 people dying in England a year, predicted to rise to 550 000 by 2035 ■ Significant progress has been made across the country in making high-quality personalised end-of-life care a reality for all who require it has been hastened in people who were not dying imminently through over-prescription of powerful analgesics.…”