Concerns over end of life care pathways

The withdrawal of The Liverpool Care Pathway from the UK following a damning review linking its implementation to poor care outcomes has created an urgent need for rigorous research in Australia, researchers have argued.

 

The withdrawal of The Liverpool Care Pathway from the UK following a damning review linking its implementation to poor care outcomes has created an urgent need for rigorous research in Australia, researchers have argued.

Writing in the Medical Journal of Australia on Monday, nurse researcher at the Royal Brisbane and Women’s Hospital Dr Raymond Chan and his co-authors said the widespread adaptation of the LCP in Australian acute care services and residential aged care facilities had occurred largely without robust evidence.

The authors said the benefits and harms of end of life care pathways remained poorly understood and their widespread adoption and policy endorsement in Australia posed a dilemma.

The LCP was designed in the 1990s to guide care for people with cancer who were in their last days of life and expected to die in hospital and rapidly evolved to be adopted by more than 1,800 healthcare institutions in the UK.

In Australia, the National Palliative Care Strategy, endorsed by Australia’s health ministers in 2010, includes support for a national roll out of an integrated care pathway across all care sectors and the Australian government-funded Palliative Approach toolkit for residential aged care providers includes advice on how to implement an end of life care pathway.

Dr Chan and his co-authors called for randomised evaluations and ongoing monitoring to be conducted to thoroughly measure the outcomes for patients in Australian healthcare settings.

In the meantime, the authors said, Australian practitioners should review each of the shortfalls and adverse outcomes of the LCP highlighted by the UK review.

The authors wrote:

“Australia needs to respond to these concerns that have been so carefully documented at a time when end of life awareness continues to rise. There is no room for complacency.

“Rather than pursuing an end of life care strategy based on limited evidence, we urge policymakers to continue to invest in building the palliative care capabilities of the Australian health care workforce, extending the reach of palliative care services and building the palliative care evidence base through investing in rigorous research.”

The UK review into the LCP was commissioned in 2013 due to serious concerns arising from reports that patients were wrongly being denied nutrition and hydration whilst placed on the pathway.

Although recognising the pathway, when applied correctly, helped patients to have a dignified and pain-free death, the review panel said they heard too many cases where the LCP was simply used as a tick box exercise. The independent review said the tool was also too generic in approach for the needs of some people.

Dr Yvonne Luxford, CEO of Palliative Care Australia, said the UK review showed that inappropriate implementation of the pathway, rather than the clinical tool itself, was to blame for poor care outcomes.

She said the adaptation of the LCP in Australia had to be well supported by staff training to avoid the implementation problems experienced in the UK.

While emphasising the importance of ongoing evaluation, she told Australian Ageing Agenda she did not believe the findings of the UK review should trigger a change in Australia’s National Palliative Care Strategy.

“We need to ensure we have good educational processes around the implementation of any end of life care pathway and that it is really clear to any health and aged care professional what the purpose of the tool is. We also need to make sure that the pathways, where they are used, are well-evaluated.”

Tags: care-pathways, end of life, mja, yvonne-luxford,

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