The Liverpool Care Pathway (LCP) influencing the UK national agenda on care of the dying

Marie Curie Palliative Care Institute, Liverpool L25 8QA, UK.
International journal of palliative nursing 04/2005; 11(3):132-4. DOI: 10.12968/ijpn.2005.11.3.18032
Source: PubMed
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    • "Nevertheless, concluding their discussion of the LCP's influence on end-of-life care, Ellershaw and Murphy (2005), important and influential contributors to this field, identified that 'optimising symptom control' (p. 134) required attention. "
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    ABSTRACT: This paper calls into question whether and how end-of-life care pathways facilitate the accomplishment of a 'good death'. Achieving a 'good death' is a prominent social and political priority and an ideal which underpins the philosophy of hospice and palliative care. End-of-life care pathways have been devised to enhance the care of imminently dying patients and their families across care settings and thereby facilitate the accomplishment of a 'good death'. These pathways have been enthusiastically adopted and are now recommended by governments in the UK as 'best practice' templates for end-of-life care. However, the literature reveals that the 'good death' is a nebulous, fluid concept. Moreover, concerns have been articulated regarding the efficacy of care pathways in terms of their impact on patient care and close analysis of two prominent end-of-life pathways reveals how biomedical aspects of care are privileged. Nonetheless drawing on a diverse range of evidence the literature indicates that end-of-life care pathways may facilitate a certain type of 'good death' and one which is associated with the dying process and framed within biomedicine.
    European Journal of Cancer Care 11/2011; 21(1):20-30. DOI:10.1111/j.1365-2354.2011.01301.x · 1.56 Impact Factor
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    • "The LCP provides education and feedback to professionals involved in terminal care and identifies room for improvement by highlighting areas where goals have not been attained [20]. LCP delivered care also has an effect on relatives as levels of bereavement are statistically significantly lower in relatives of those treated by the LCP when compared to those not treated [ "
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    ABSTRACT: Despite advances in burn care some injuries remain non survivable. Good end of life care for these patients is arguably as important as life prolonging care. The Liverpool Care Pathway is a useful tool for providing good quality end of life care. It has previously been modified for the acute setting. We modified it further specifically for use in burn care in 2007 and would like to share our experience of using it. A retrospective case series of deaths occurring between 01/01/08 and 31/12/09 is presented and adherence to the Burn Modified Liverpool Care Pathway (BM-LCP) is assessed. There were 22 deaths over the study period with a mean TBSA of 55%. Mean Acute Burn Severity Index score (ABSI) 12.5. A decision of futility was made in 14 cases, 11 of these were started on the BM-LCP. 7 were started on the pathway at the time of admission. Mean time from decision to start the pathway to death 11 h (range 3-48). There were no variances from the pathway. The BM-LCP appears to be an appropriate tool for assisting in end of life care in burns and when used appears to improve end of life care. We recommend its use and would encourage others to implement its use.
    Burns: journal of the International Society for Burn Injuries 04/2011; 37(6):981-5. DOI:10.1016/j.burns.2011.03.012 · 1.88 Impact Factor
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    • "A key message given by the National Council for Hospice and Specialist Palliative Care Services (NCH- SPCS) (2001) is that end of life care is distinctive from other palliative care and indeed requires a 'gear change'. This approach to care can be in conflict with care cultures that prioritize a cure philosophy (Ellershaw and Murphy, 2005). Practitioner knowledge base may also require development (Royal College of General Practitioners, 1995). "
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    ABSTRACT: This paper is a description of two approaches to the implementation of an end of life integrated care pathway in the north east of England. It draws on an evaluation of the introduction of the pathway to explore the transference of knowledge held by the specialist palliative care team to local ownership by primary health care team members. It reports a successful practice development change and details how neighbouring primary care trusts developed two models for managing the resources of time and expertise. One opted to buy in specialist practitioner time, the other to buy out generalist time. The paper focuses on the lessons learned from these two experiences of facilitation of change.There is already a literature base detailing factors influencing successful care pathway implementation. This discussion adds another dimension to this literature in exploring how a range of success criteria is packaged in two different approaches to practice development.The resource of time is a central factor in achieving practice development success. However, buying time resource should not be seen as a panacea to overcoming practice development barriers. Other factors such as clear leadership, good education and communication are also required to provide an environment conducive to facilitating practice development. Copyright © 2005 John Wiley & Sons, Ltd.
    Practice Development in Health Care 12/2005; 4(4):171 - 179. DOI:10.1002/pdh.21
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