Developed in the s to address barriers to the delivery of excellent care in the final days of life, the LCP was designed to support the high standard of palliative care prevalent in hospices to other clinical settings.
It provided guidelines for best practice, focusing on symptom control, appropriate discontinuation of active treatments, psychological, social, and spiritual care of patients and their families, and frequent patient reassessment. Despite widespread support across the majority of the healthcare professions, 3 the Review report is unequivocal: use of the LCP must cease.
The debate surrounding the LCP has revealed a deep reluctance in UK society to address issues of mortality, by patients, relatives and healthcare professionals alike. Hospitals are seen as places to heal and prolong life; acceptance of dying and death is interpreted as giving up, ceasing to try, even as approaching euthanasia.
Doctors may have a sense of failure and fear complaints or litigation for not doing enough. General Medical Council guidance is clear:. Sadly, it is undeniable that the Review and the media have highlighted examples of extremely poor practice.
What is the Liverpool Care Pathway?
Many cases revealed ineffective or absent communication between healthcare professionals and patients or relatives, resulting in appalling care when this happened. However, the LCP repeatedly emphasised the importance of clear and open communication with the patient and family and within the multidisciplinary team.
It provided an outline structure to assist the more anxious, inexperienced, or reluctant professional with the difficult areas of communication known to form the basis of the majority of complaints in relation to end-of-life care. Particular concern was raised in the Review about reports of patients being denied oral fluids, contrary to the legal requirement to provide basic care:.
Liverpool care dying pathway pdf viewer
The Review also identified reports of withdrawal of nutrition and hydration by drip or tube, without explanation or consultation. A further relevant issue is the uncertainty inherent in identification of the dying phase, especially in non-malignant disease.
Most of the cases of poor care reported to the Review body related to the older patients with non-cancer diagnoses. Three-quarters of deaths in the UK are from non-cancer causes, yet these patients make up a minority of patients on GP palliative care registers 7 often only being recognised as needing end-of-life care when very close to death.
The application of any guideline or integrated care pathway without good clinical judgement will result in poor clinical care. Guidelines are written to guide, not to dictate. This is identified as a necessary outcome for medical student education in the UK 14 although, as demonstrated by the annual meetings of the Association for Palliative Medicine Undergraduate Education Special Interest Forum, the allocated curriculum time, content and mode of delivery for palliative and end-of-life care still varies greatly between medical schools.
That being said, the resultant situation leaves us with some serious concerns. The LCP was designed to apply best hospice practice in settings less well suited to end-of-life care, especially acute hospital wards, intensive care, and accident and emergency units 14 where good end-of-life care may be difficult alongside the need for rapid diagnosis and active clinical management.
The LCP provided a framework for non—palliative care specialist clinicians to deliver good end-of-life care in a wide range of clinical settings.
Liverpool Care Pathway To Be Scrapped
The Review recommended that the formal care pathway be replaced with a series of condition specific information booklets. Such booklets could fragment rather than enhance care and, in the absence of unifying documentation, busy health professionals may simply neglect to use these new resources, reverting to a situation of ad hoc, poorly guided care.
Equally concerning are the international repercussions of the Review.
The UK was the origin of the global palliative care movement in the s and remains at the forefront of developments. Internationally, palliative care provision still encounters fundamental obstacles and one-third of countries have no hospice or palliative care activities whatsoever. Globally, the LCP has proved a key tool in the development of palliative care in countries as diverse as Argentina, Slovenia, India, Norway, and the Netherlands. Perhaps the LCP is now irredeemable, but as we learn lessons and look to the future, the adverse publicity surrounding it should not be used as a means for politicians and healthcare professionals to avoid tough questions about the culture of care in the NHS.
The views expressed in this Editorial are those of the authors alone. The authors have declared no competing interests.
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This article has been cited by other articles in PMC. Notes Provenance Commissioned; not externally peer reviewed.
More care, less pathway. A review of the Liverpool Care Pathway.
Liverpool Care Pathway for the Dying Patient
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What is palliative care?
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The Liverpool Care Pathway for the dying: what went wrong?
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THE WAYS FORWARD
J Pain Symptom Manage. Francis R. London: HMSO; Support Center Support Center.