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Evidence based practice

Do end of life care pathways improve symptoms and quality of life for patients and families?

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End of life care pathways standardise care of the dying and guide nurses. This Cochrane review aimed to explore whether following them ensures patients receive care that provides comfort and dignity

Keywords End of life, Care pathways, Quality of life, Dying, Families

Review question

Do end of life care pathways, compared to usual care (no pathway), affect symptom severity and quality of life for those who are dying as well as their families?

Nursing implications

Nurses are at the bedside delivering end of life interventions that affect the care provided to patients and their families. An end of life care pathway standardises care and guides nurses to ensure that all patients who are dying receive care that provides comfort and dignity. Therefore, data needs to be collected to ensure that the care given produces these outcomes.

Study characteristics

Randomised controlled trials (RCTs), cluster RCTs, quasi RCTs and controlled before and after studies comparing end of life care pathways to a usual care group or to another end of life care pathway were considered. Studies could be conducted in any setting, such as hospitals, care homes and patients’ homes.

No age limit for participants was set and there was no exclusion based on the disease processes leading to the end of life. All participants must have been receiving end of life care interventions for their last days or hours of life.

The primary outcomes being measured were physical symptom severity (by any instrument), psychological symptom severity (by any instrument), quality of life (by any instrument) and any harm.

Secondary outcome measures included advanced care planning occurrence, communication (measured by occurrence of family meetings), caregiver wellbeing, grief and bereavement, patient/staff/caregiver satisfaction, staff confidence, cost of intervention, cost of care, medication/treatment use and spiritual needs.

The databases searched were Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsyclNFO, CINAHL, Web of Science, ProQuest Dissertations and Theses Database (PQDT) and Google .

Summary of key evidence

Nine hundred and twenty titles and abstracts were assessed for eligibility. However, no study fulfilled the criteria.

Best practice recommendations

Since no studies met the criteria for inclusion, no conclusions can be made regarding the effect of end of life care pathways on symptom severity and quality of life for those dying and their families. Well designed RCTs and other study designs are needed to evaluate the effectiveness of clinical pathways on outcome for end of life care.

GLENN CARLSON, MSN, ACNP-BC, CCRN, is clinical nurse specialist at Bronson Methodist Hospital, Kalamazoo, Michigan, and a member of the Cochrane Nursing Care Field.

  • The full report, includiong references, can be read here.
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