Twigger, S. & Yardley, S.J. Palliative Medicine. Published online: December 8 2016
Background: The Liverpool Care Pathway was used in UK hospitals (late 1990s to July 2014) in an attempt to generate hospice-style high-quality end-of-life care in acute settings. Despite being widely established, there was limited research or contextual evidence regarding this approach or its impact. Growing criticism from the public, media, politicians and healthcare professionals culminated with a critical independent review (July 2013) and subsequent withdrawal of the Liverpool Care Pathway.
Conclusion: Future initiatives in hospital end-of-life care must address doctors’ fears, (in)abilty to tolerate medical uncertainty, communication skills and understanding of the dying phase, in order to provide optimum care in the last days of life.
The LCP was widely used with an aim to improve communication and care for dying individuals and their relatives. However, widespread media criticism prompted a review, which resulted in the discontinuation of the LCP across U.K. clinical settings.1 Three key themes emerged: 1) “lessons learned”; 2) “uncertainties and ambivalences”; and, 3) “the future.” Critical care practitioners reported life after the LCP … often involved various clinical ambivalences, uncertainties and inconsistencies in the delivery of end-of-life care (EOLC), especially for less experienced practitioners. They had “become accustomed” to the components of the LCP, which still guide them in principle to ensure quality EOLC. The LCP’s format was perceived to be a useful clinical tool, but was criticized as a “tick-box exercise,” and for lacking family involvement. Despite experienced practitioners being able to deliver quality EOLC without using the LCP, junior nursing and medical staff need clear guidelines and support from experienced mentors in practice. Evidence-based guidelines related to family involvement in EOLC planning in critical care settings are needed to avoid future controversies.
The effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the U.K. hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards. Phase 0 consisted of a review of existing LCP programmes from the U.K., Italy, and The Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, the authors developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. Results of Phase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation, and a summary of the LCP concerns raised in the U.K. Based on these findings the authors developed a new care programme consisting of: 1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward; 2) supportive documentation; and, 3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.
Reference: Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: A phase 0-1 study according to the Medical Research Council Framework