Liverpool Care Pathway Introduction Over the past twenty years since its implementation, the Liverpool Care Pathway (LCP) for the dying has become one of the most disputed management of care in the modern times. As such, there has been an increased interest in the media and public discussions which have undoubtedly raised serious questions about its efficacy in providing high quality care for the dying patient…
On the contrary, other sources including that of the Health Minister Jeremy Hunt who describes it as “a fantastic step forward” (Donnelly, 2013) still maintain their favour believing that the pathway is playing its intended role of ensuring that people are treated in dignity, compassion and comfort during their last days of life instead of enduring invasive and life prolonging treatments (Randall and Downie, 2010, p.91). As a result of these controversies, the government ordered an independent review in 2012 chaired by Baroness Neuberger. The review finding recommends the Liverpool Care Pathway to be phased out and be replaced by a personalised end of life care plan that takes good care of the life of a patient who is facing imminent death (Department of Health, 2013). The LCP has clearly set the stage for ethical and legal controversies about patients, family rights and the role of the medical professions (Glare and Christakis 2008, p. 429). Replacing the LCP to a personalised end of life care plan may not resolve the controversies if the same transgressions persist. In that context, this paper aims to objectively review the literature and explore the challenges that contributed to its failure in order to accurately consider the future development of the recently recommended personalised End of Life Care Plan. Overview The Liverpool Care Pathway for the dying patient was developed as an integrated care pathway by the specialist palliative care team at the Royal Liverpool and Broadgreen University Hospitals NHS Trust and the Marie Curie palliative care institute Liverpool in 1997 (Ellershaw and Wilkinson, 2003, p. 11). The LCP is a structured clinical record developed to transfer the hospice model of care into other care settings (Jack, Gamble, Murphy, and Ellershaw 2003, p. 371). It aims to support clinical judgements and assist multidisciplinary team in providing optimal treatment and care for patients who are dying(Boyd and Murry 2012), as well as improve the experience of the relatives or carers during this period and into bereavement (Gambles, Roberts and Anita 2011). It focuses in providing evidence-based framework on different aspects of care required including comfort measures, discontinuation of inappropriate intervention among others (Ellershaw and Murphy 2011, p. 11). The Liverpool Care Pathway was advocated by the Department of Health (2012) as a model of good practice in End of Life care and quality makers and measures for promoting high quality care for all adults in the end of life (MCPCIL). Additionally, the General Medical Council (General Medical Council, 2010) supported it, over 20 organisations and charities as demonstrated in the consensus report for its support published by the NHS in 2012 and the National Institute for Health Care Excellence (NICE) Quality Standard for End of Life care for adults. Regardless of its high approvals and recommendations, the LCP has been blamed for delivering poor quality care to patient in their final days (Payne, Seymour, Ingleton 2008, p.392). The independent review findings identified a number of important issues that affected the ability to implement the LCP effectively in the provision of quality healthcare to persons who are almost dying or facing imminent death. Amongst which were lack of knowledge and ...
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