The Liverpool Care Pathway (LPC) was a framework for end of life care, summarised in a document to be followed by the doctors and nurses involved in the care of the dying patient. It was originally devised to translate the excellent model of care shown by hospices into other healthcare settings, such as hospitals.
Before its implementation and with an absence of guidance, care was of variable quality by inexperienced junior doctors and so it was created as a template for providing good care.
Before its introduction it had not been critically appraised from an evidence basis which is an important consideration. This would have given everybody greater insight into its efficacy, and then helped us decide if we should continue to use it. Sadly research into palliative care is severely lacking despite it being an area that will affect a huge amount of individuals greatly; it doesn’t seem to make much money though.
– In 2012 85 per cent of NHS trusts had adopted the Liverpool Care Pathway.
The LCP had become well established in hospitals and was considered by many palliative care consultants a useful starting point for anyone inexperienced in palliative medicine.
The daily mail has decided that this “pathway to death” (they actually printed this!) was knocking off old and frail people up and down the country and some sensationalist coverage would be needed to scrap this abhorrent document. Headlines were generated furiously and as a result of the ensuing chaos an enquiry by Baroness Neuberger in the summer of 2013 published its findings. It came to the conclusion that there had been significant collateral damage from the coverage of purely anecdotal evidence and so it should be scrapped.
Replaced by individualised care plans, whatever that nicely vague term means.
– Patrick Pullicino of the Daily Mail, referred to the LCP as “euthenasia of the elderly”
Has anyone considered the result of its absence and will this hurt patients care? Maybe a good quality trial would actually help us determine the evidence base for using the LCP and whether it is a good or bad tool. It has been accused of being a tick box exercise for poor care.
Is it then suddenly the guidance’s fault for its reader’s ineptness or lack of compassion? Do we decide that the Highway Code is now a dangerous entity because some drivers do not follow it properly and have accidents?
No, we do not and we certainly don’t decide to abolish it and instead leave a massive gaping hole in its place.
– The Journal of Palliative Medicine described the approach enhanced patient dignity and care.
If they were determined enough for a news scoop they could pick up a strong handful of patients with tear jerking stories worthy of an Oscar nomination telling you they have had negative experiences of a tool or intervention that has massive scale. It would not mean that this practise was inherently bad; to come to that conclusion you would need to look at more data and see the bigger picture.
Maybe the Daily Mail and many other mainstream news agencies should consider the impact on people’s lives and health they damage by making spurious comments. The LCP needed a review based on evidence a philosophy seemingly in short supply.
Knee jerk responses have greater short term effect and silence the angry mob much quicker, till the next health scare anyway!
Jonathan Derrick