Why is the Liverpool care pathway used for some dying cancer patients and not others? Healthcare professionals’ perspectives
- Publisher: BioMed Central
BMC Research Notes
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.