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Less than 50% of terminally ill patients put on Liverpool Care Pathway

  • 27 Comments

Less than half of all terminally ill patients are placed on the nationally recommended Liverpool Care Pathway for the Dying Patient (LCP), new research has revealed.

In many parts of England, medical staff have limited training or support to use the care pathway, according to a study published in the BMJ Supportive & Palliative Care journal.

The pathway was developed by the Marie Curie Hospice Liverpool and the Royal Liverpool University Hospitals in 2003 to help healthcare staff caring for patients dying of cancer in hospitals.

It has since been expanded to include all dying patients and has been implemented across the world in primary and secondary care settings.

The pathway provides a framework for structuring and coordinating multidisciplinary care for the last 72 hours of life and facilitates audit by standardising the monitoring of patient needs, symptoms and care.

However, until recently there had been little reliable information on how frequently the LCP was used across the country.

Researchers at Durham University’s Wolfson Research Institute for Health and Wellbeing reviewed the evidence of the eligibility, uptake and non-uptake of the LCP in various settings.

Collectively, 18,052 patients were placed on the LCP, in a variety of inpatient and primary care settings, and cancer and non-cancer diagnoses, the study’s authors found.

In the UK, the LCP is cited in National Institute of Health and Care Excellence guidance as an example of good practice.

Nevertheless, the LCP has been the source of media controversy, with stories in the national press last year describing it as the “equivalent of euthanasia for the elderly”.

There were also claims that many doctors considered it “worthless”, leading to hundreds of complaints to the Press Complaints Commission.

A poll published by BMJ and Channel 4’s Dispatches in March this year found that 89% of palliative care experts backed the pathway and would choose it for themselves.

However, three-quarters (74%) of palliative medicine consultants said the negative media coverage had led to less use of the pathway.

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  • 27 Comments

Readers' comments (27)

  • Yep, the Liverpool Pathway is now a no-no where I work, following the furore created by the media in recent times. Numerous times - when relatives have been given the news that their loved-ones condition is now entering into the palliative stage - have I heard them say: "I don't want them on that pathway."

    I fear we'll end up back where we were before the pathway was introduced which can't be a good thing for palliative care.

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  • Too much time filling in forms whilst the patient died five minutes previously alone and without the carer holding their hand who had felt safe to nip out to get another form but had to print off fresh ones whilst the nurse sits in the office completing the LCP audit and updating care plans ready for the forthcoming inspection.
    Bring back real nursing, not one man semi-automatic care teams who look to academics and lawyers for guidance and not wise counsel based upon compassion and experience.

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  • michael stone

    'The pathway provides a framework for structuring and coordinating multidisciplinary care for the last 72 hours of life and facilitates audit by standardising the monitoring of patient needs, symptoms and care.'

    How can you be 'on' a framework - and isn't individualised care, something that will potentially be lost if people think of this framework as 'a pathway' ?

    All dying patients should be treated as individuals, and as part of social/family groups where that is the case, appropriate palliation should be offered (which is where 'evidence-based' medicine comes in: working out what works, and therefore what it makes sense to offer) and those clinicians caring for the dying should KEEP THINKING.

    The LCP, when viewed as a combination of a description of 'tested methods of care' AND AS A PROMPT (the prompt being to change mindsets from 'cure' to 'helping to die') makes great sense - it becomes wrong, however, if it is thought of 'as how patients will die, and something we therfore fit patients into'.

    I think - not quite sure - that much the same was being said by:

    Anonymous | 4-Jun-2013 3:27 pm



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  • There is so much to say but is it safe given the all round controversy? Try approaching the subject from a personal perspective and imagine dying against what you see routinely applied in these circumstances. Would you want morphine confusion and a hyoscine dry mouth with carers not giving you anything in case you aspirate? Think of a child taking an uncertain step..what do they need?..a hand.

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  • Why will people not accept when their loved ones are dying? I've recently started working in a hospice and have been very impressed by the standard of care and the individualisation of people's needs as they enter the final stages of their lives. The LCP is useful as a check list to ensure that everything is in place and prescribed to make things comfortable, so that the nurses and the family can concentrate on making those last precious days or hours as gentle as possible.

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  • Anonymous | 4-Jun-2013 8:10 pm

    "Why will people not accept when their loved ones are dying?"

    hopefully you will learn about the psychology of bereavement whilst you are there which will help answer your question. the writings of Elizabeth Kübler-Ross are also an excellent source of information.

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  • Anonymous | 4-Jun-2013 8:10 pm

    "Why will people not accept when their loved ones are dying?"

    You have a lot to learn and one can only hope that you learn quickly.

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  • Anonymous | 4-Jun-2013 3:27 pm

    "Bring back real nursing, not one man semi-automatic care teams who look to academics and lawyers for guidance and not wise counsel based upon compassion and experience."

    Exactly.

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  • Tinkerbell

    Anonymous | 4-Jun-2013 5:05 pmThink of a child taking an uncertain step..what do they need?..a hand'

    What a lovely way to put it.

    I once attended a personal course with Elisabeth Kubler Ross, a lovely lady, so very down to earth, so encouraging. We shared a fag together in the grounds of the castle where we were staying but she didn't want anyone to know she had one in case it reflected badly on her in the press. Now she's no longer with us i guess
    she doesn't care.

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  • tinkerbell | 4-Jun-2013 10:39 pm

    you are very privileged.

    she wrote her last book with a co-author when she was dying herself. she had so much insight into the feelings and needs of dying patients having written numerous books and interviewed hundreds of dying patients. I once heard on the radio a doctor recommend that every member of the caring professions should read her book 'On Death and Dying'. It has been on my list ever since and for such a long time but somehow other things always seem to need attention and take priority but I am sure it is well worth the read.

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