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

Article English OPEN
Freemantle, Alison ; Seymour, Jane (2012)
  • Publisher: BioMed Central
  • Journal: BMC Research Notes (vol: 5, pp: 524-524)
  • Related identifiers: doi: 10.1186/1756-0500-5-524, pmc: PMC3532332
  • Subject: Biochemistry, Genetics and Molecular Biology(all) | Liverpool care pathway | Medicine(all) | Cancer | Short Report | Qualitative research | Hospital | Healthcare professionals | End-of-life care

Background: Despite evidence suggesting that the Liverpool Care Pathway for the Dying Patient is a structured\ud and proficient means of supporting care delivery in the last hours or days of life, discrepancies in uptake are\ud widespread. This exploratory study sought to understand why patients dying of cancer in oncology wards of one\ud hospital trust were, or were not, supported by the LCP. A purposive qualitative case study design was used; each\ud case represented a patient who had died and their most involved nurse and doctor. In-depth interviews explored\ud both recollections of the ‘case’ and wider experiences of using the Pathway in end-of-life care. Eleven healthcare\ud professionals were interviewed about their involvement in the end-of-life care of six patients. For four of these\ud patients care was supported by the LCP.\ud Findings: Although doctors and nurses reported they preferred to use the Pathway to ensure comfortable death,\ud an important factor influencing their decisions was time of death. Access to timely senior review was regarded as\ud an essential preliminary to placing patients on the Pathway but delayed access ‘out of hours’ was commonly\ud experienced and tensions arose from balancing conflicting priorities. Consequently, the needs of dying patients\ud sometimes failed to compete with those receiving curative treatment.\ud Conclusions: This study suggests that greater attention should be focused on ‘out of hours’ care in hospitals to\ud ensure regular senior review of all patients at risk of dying and to support front line staff to communicate\ud effectively and make contingency plans focused on patients’ best interests.
  • References (21)
    21 references, page 1 of 3

    1. Davies E, Higginson IJ: Palliative care: the Solid Facts. [http://www.euro.who. int/__data/assets/pdf_file/0003/98418/E82931.pdf].

    2. Ellershaw JE, Wilkinson S: eds: Care of the Dying: A pathway to excellence. Oxford: Oxford University Press; 2003.

    3. Jack B, Gambles M, Murphy D, Ellershaw J: Nurses' perceptions of the Liverpool Care Pathway for the dying patient in the acute hospital setting. Int J Palliat Nurs 2003, 9:375-381.

    4. Walker R, Read S: The Liverpool Care Pathway in intensive care: an exploratory study of doctor and nurse perceptions. Int J Palliat Nurs 2010, 16:267-273.

    5. Di Leo S, Beccaro M, Finelli S, Borreani C, Costantini M: Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital. Palliat Med 2011, 25:293-303.

    6. O' Hara T: Nurses' views on using the Liverpool Care Pathway in an acute hospital setting. Int J Palliat Nurs 2011, 17:239-244.

    7. Mullick A, Beynon T, Colvin M, Morris M, Shepherd L, Cave L, Lowell J, Asmall N, Carey I: Liverpool care pathway carers survey. Palliat Med 2009, 23:571-572.

    8. Veerbeek L, Zuylen L, Swart S, van der Mass P, de Vogel-Voogt E, van der Rijt C, van der Heide A: The effect of the Liverpool Care Pathway for the Dying: a multi-centre study. Palliat Med 2008, 22:145-151.

    9. Veerbeek L, van de Heide A, de Vogel-Voogt E, Bakker R, van der Rijt C, Swart S, van der Maas P, Zuylen L: Using the LCP: Bereaved Relatives' Assessments of Communication and Bereavement. Am J Hosp Palliat Care 2008, 25:207-214.

    10. National Institute for Clinical Excellence: Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer. London: NICE; 2004.

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