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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