Why is the Liverpool care pathway used for some dying cancer patients and not others? Healthcare professionals’ perspectives

Abstract

BackgroundDespite evidence suggesting that the Liverpool Care Pathway for the Dying Patient is a structured and proficient means of supporting care delivery in the last hours or days of life, discrepancies in uptake are widespread. This exploratory study sought to understand why patients dying of cancer in oncology wards of one hospital trust were, or were not, supported by the LCP. A purposive qualitative case study design was used; each case represented a patient who had died and their most involved nurse and doctor. In-depth interviews explored both recollections of the ‘case’ and wider experiences of using the Pathway in end-of-life care. Eleven healthcare professionals were interviewed about their involvement in the end-of-life care of six patients. For four of these patients care was supported by the LCP.FindingsAlthough doctors and nurses reported they preferred to use the Pathway to ensure comfortable death, an important factor influencing their decisions was time of death. Access to timely senior review was regarded as an essential preliminary to placing patients on the Pathway but delayed access ‘out of hours’ was commonly experienced and tensions arose from balancing conflicting priorities. Consequently, the needs of dying patients sometimes failed to compete with those receiving curative treatment.ConclusionsThis study suggests that greater attention should be focused on ‘out of hours’ care in hospitals to ensure regular senior review of all patients at risk of dying and to support front line staff to communicate effectively and make contingency plans focused on patients’ best interests.

Care professional's experiences about using Liverpool Care Pathway in end‐of‐life care in residential care homes

“…In a mixed‐methods study, RNs, ENs, social workers, a medical intern, a medical fellow and a medical consultant were supported when using the LCP in acute care settings in areas such as diagnosing dying, symptom control, consulting a specialist in palliative care, knowledge, confidence, communication and teamwork . Qualitative studies also support the value of using the LCP in oncology hospital wards , acute hospitals and hospices . However, in the UK there has been debate and criticism over the use of the LCP.…”

Evaluating the Liverpool Care Pathway for care of the terminally ill in rural Australia

“…[10,11] Previous studies have shown that end-of-life ICPs, particularly the LCP, are generally well regarded by health care professionals and are perceived to improve the care of dying patients, particularly with regard to symptom control, communication and documentation of care. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The LCP is now used in over 20 countries worldwide. [27] Nevertheless, the evidence supporting the LCP's effectiveness in obtaining a good death remains equivocal.…”

The characteristics of patients who discontinue their dying process – an observational study at a single university hospital centre

“…Our data show a benefit and necessity for routine IPT reassessment during care for the dying. This assessment is an important contributing factor in diagnosing non-dying patients in the LCP [ 53 ]. Interprofessional teamwork has received increasing attention within healthcare and care for the dying in particular [ 17 , 53 ].…”

“…This assessment is an important contributing factor in diagnosing non-dying patients in the LCP [ 53 ]. Interprofessional teamwork has received increasing attention within healthcare and care for the dying in particular [ 17 , 53 ]. However, it takes time to control symptoms, ensure good communication and support families within a team approach [ 9 ].…”