The Liverpool Care Pathway

For many practising doctors, especially in general practice or in general internal medicine, decisions at the end of life are often some of the most difficult. Not only is decision making difficult, but implementation may create a further set of problems. Most of us are orientated to doing something – usually something that is active, promoting life or health. Many end of life decisions demand something different: the acceptance that life is coming to an end and that the quality of the final phase of the patient’s illness is to offer a good death. The doctor must reorientate his or her thinking to a different, less distinct target. Reference to the the development of the Liverpool Care Pathway for the dying patient (LCP).peer-reviewe

Factors associated with the goal of treatment in the last week of life in old compared to very old patients: a population-based death certificate survey

Background: Little is known about the type of care older people of different ages receive at the end of life. The goal of treatment is an important parameter of the quality of end-of-life care. This study aims to provide an evaluation of the main goal of treatment in the last week of life of people aged 86 and older compared with those between 75 and 85 and to examine how treatment goals are associated with age. Methods: Population-based cross sectional survey in Flanders, Belgium. A stratified random sample of death certificates was drawn of people who died between 1 June and 30 November 2007. The effective study sample included 3,623 deaths (response rate: 58.4%). Non-sudden deaths of patients aged 75 years and older were selected (N = 1681). Main outcome was the main goal of treatment in the last week of life (palliative care or life-prolonging/curative treatment). Results: In patients older than 75, the main goal of treatment in the last week was in the majority of cases palliative care (77.9%). Patients between 75 and 85 more often received life-prolonging/curative treatment than older patients (26.6% vs. 15.8%). Most patient and health care characteristics are similarly related to the main goal of treatment in both age groups. The patient's age was independently related to having comfort care as the main goal of treatment. The main goal of treatment was also independently associated with the patient's sex, cause and place of death and the time already in treatment. Conclusion: Age is independently related to the main goal of treatment in the last week of life with people over 85 being more likely to receive palliative care and less likely to receive curative/life-prolonging treatment compared with those aged 75-85. This difference could be due to the patient's wishes but could also be the result of the attitudes of care givers towards the treatment of older people

Dying in hospital in Ireland: an assessment of the quality of care in the last week of life: National audit of end-of-life care in hospitals in Ireland, 2008/9

The context of this report is set by the fact that most people die in a hospital or similar setting, outside the home. When you consider that most people are also born in hospital, and may spend some time there over the course of a lifetime, it becomes clear that hospitals are central to our passage into life and out of it, touching people at the most important and intimate moments of their lives. In this sense, the work of hospitals mirrors the cycle of life and the expectations of society about its role at each stage of the life cycle. The report assesses the quality of care provided by Irish hospitals in the last week of life. The word ‘hospital’ shares a common linguistic root with words like hospice and hospitality. Hospitality – understood as being welcomed and cared for with kindness and attentiveness - is still what everyone seeks when they come to hospital, including patients and their families who are going through the journey of dying, death and bereavement. That is why the Hospice Friendly Hospitals Programme (2007-2012) commissioned this first ever national audit of endof-life care in Irish hospitals. This report contributes to the growing practice within the Irish hospital system of auditing performance against standards in order to ensure that every aspect of its work meets, and even exceeds, the highest standards of care and excellence. Given that end-of-life care standards did not exist at the time the audit – but have since been published as Quality Standards for End-of-Life Care in Hospitals1 – it may be more appropriate to regard this report as a ‘pre-audit’ or ‘baseline-audit’. It is Government policy, since February 2009, to introduce a mandatory licensing system whereby each hospital will only be allowed to practice if, on the basis of audited performance, it meets acceptable quality standards of service

Barriers to providing palliative care for older people in acute hospitals

Background: the need for access to high-quality palliative care at the end of life is becoming of increasing public health concern. The majority of deaths in the UK occur in acute hospitals, and older people are particularly likely to die in this setting. However, little is known about the barriers to palliative care provision for older people within acute hospitals. Objective: to explore the perspectives of health professionals regarding barriers to optimal palliative care for older people in acute hospitals. Methods: fifty-eight health professionals participated in eight focus groups and four semi-structured interviews. Results: participants identified various barriers to palliative care provision for older people, including attitudinal differences to the care of older people, a focus on curative treatments within hospitals and a lack of resources. Participants also reported differing understandings of whose responsibility it was to provide palliative care for older people, and uncertainly over the roles of specialist and generalist palliative care providers in acute hospitals. Conclusions: numerous barriers exist to the provision of high-quality palliative care for older people within acute hospital settings. Additional research is now required to further explore age-related issues contributing to poor access to palliative care

The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

<p>Abstract</p> <p>Background</p> <p>Most cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now.</p> <p>Methods and design</p> <p>This is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit.</p> <p>The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit <it>"After-death Bereaved Family Member Interview</it>".</p> <p>Discussion</p> <p>This study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm.</p> <p>Research ID</p> <p>RFPS-2006-6-341619</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01081899">NCT01081899</a></p

Understanding integrated working between arts and care settings: an analytical framework for planning and research

Purpose – The purpose of this paper is to discuss integrated working between the arts and those in care settings. Identifying that the field is very broad, with diverse evidence and experience within it, the paper argues that there is a need to find ways in which to be clearer about the purpose of specific arts and care integrated projects. The paper draws on a case study project to develop some insights and a framework to help address this challenge. Design/methodology/approach – The paper is a conceptual discussion and development drawing upon insights from relevant literature and a case study analysis of an integration project between a hospice service, an art gallery and an artist. Findings – The integrated working case study project between the hospice, art gallery and artist highlights some points about a lack of conceptual frameworks to help locate the purpose of diverse arts and care projects. There is scope for much confusion about the nature and purpose of such integration projects without a clear framework for articulating the aims of individual integration endeavours and their place in relation to other arts and care work. This paper develops a framework and a clear understanding about the different kinds and goals of integrated working between arts and care settings to help with future practical and research projects. Research limitations/implications – The paper reports a case study which highlights key themes from which generalisation to other services will require interpretation for particular contexts. Practical implications – The ideas present a helpful approach to articulating the goals of individual projects and to better understand the place of projects in relation to other arts and care initiatives. Social implications – There is much scope for better integrated working between arts and care settings to achieve better outcomes for users of care services, and the ideas presented here should help to better organise and evaluate such developments. Originality/value – This is the first paper to set out the framework presented to help with better integrated working between arts and care settings