Evaluating the Liverpool Care Pathway for care of the terminally ill in rural Australia
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This study evaluates a pilot implementation of the Liverpool Care Pathway (LCP), a clinical tool used to guide the care of dying patients in the last days of life, on the end-of-life care for dying patients in three regions in rural Australia.
The LCP was implemented at 13 participating sites: nine hospitals (general wards), one community-based palliative care service, and three in-hospital palliative care units. To evaluate the implementation of the LCP, 415 eligible patient records were examined: 223 pre-implementation and 192 post-implementation (116 on the LCP and 76 receiving usual care). The primary analysis compared all patients pre-implementation of the LCP versus all patients post-implementation.
Increases were found post-implementation for communication with other health professionals and with patients or family (pre-69 %, post-87 %; p ≤ 0.000), use of palliative medications (pre-87 %, post-98 %; p ≤ 0.000) and frequency of symptom assessments (pre-66 %, post-82 %; p ≤ 0.000). Fewer blood and radiological investigations were conducted and venous access devices used in the post-implementation groups than in the pre-implementation period.
This study suggests that when rigorously implemented, the LCP improves important components of end-of-life care for dying patients and their families.
KeywordsPalliative care Terminal care Critical pathways Quality of health care Quality improvement
Funding for this research was provided by the Western Australia State Health Research Advisory Council (SHRAC) grant no. RSD 03680/02. We would like to thank the following:
• The 16 sites in the Midwest, Southwest and Great Southern regions of the WA Country Health Service and the St. John of God hospitals in these regions who participated in this research project.
• Everyone who assisted with data collection and analysis including audit staff, medical records staff and the Western Australia Centre for Cancer and Palliative Care Research staff.
• Emma Penman and Mark Wallace, Research Associates with the Western Australia Centre for Cancer and Palliative Care Research, who provided data management and statistical analysis for the project and production of this paper.
• Most importantly, the health professionals and carers who shared their personal experiences with us, and gave so generously of their time.
Funding for this research was provided by the Western Australia State Health Research Advisory Council (SHRAC) Research Translation Projects grant no. RSD 03680/02 (http://www.health.wa.gov.au/researchdevelopment/funding/funding_prog.cfm). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Conflict of interest
Authors HW and VC were employed by the WA Department of Health for the submitted work and were involved in the implementation of the LCP cited here. The WA version of the LCP is registered with the Marie Curie Palliative Care Institute, Liverpool, UK; authors AW, CJ, HA and TR declare no competing interests relevant to the submitted work.
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