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Special report on the Liverpool Care Pathway
THE Liverpool Care Pathway (LCP) was developed in the late 1990s at the Royal Liverpool University Hospital, in conjunction with the Marie Curie Palliative Care Institute.
It was designed to provide the best quality of care for dying patients amid concerns that standards of end-of-life care were patchy. Dr Lara Alloway, lead clinician of North Hampshire palliative care service and associate medical director (end of life) at Basingstoke hospital, believes a proper understanding of the use of the LCP should alleviate such fears.
She told The Gazette: “It is important to understand that the pathway is used only when the patient is already dying. Patients are put on the pathway only when all reversible conditions have been appropriately treated and when a team, including senior doctors, believe the patient is in the last hours or days of life. The pathway does not hasten death.”
The goal of the LCP is to make death as dignified and peaceful as possible, and the response to it was largely positive in the first few years.
The aim of keeping a dying patient as comfortable as possible may include withholding fluids and nutrients if he or she has stopped being able to eat and drink – something which has been questioned by critics of the system.
The pathway process can also include the cessation of treatments if they are not in the best interests of the patient – something else which has also caused concern.
Dr Alloway said the LCP acts as “a framework for good practice” which supports those providing care to people who are in their last hours or days of life.
She said the decision is always made by a team including senior medical professionals, and she emphasised that those on the pathway can be taken off at any time.
Dr Alloway, left, explained: “Some patients will live longer than we expect and if the prognosis changes, their care will be reassessed. “Sometimes doctors do get it wrong. For that reason, the decision to put a patient on the pathway is taken by a team of clinicians. Sometimes, they are removed from the pathway.”
Patients are reviewed at least every four hours. Dr Alloway said that patients on the LCP are supported to eat food and take fluids for as long as possible, but added that losing interest in food and drink is a natural part of dying.
Food, fluids and certain medical treatments should only be stopped if they are causing pain or discomfort to the patient. Dr Alloway said a patient’s relatives are always closely involved in the process, and loved ones are always told about what decision has been made about a patient’s care.
She added: “When we sit down with the families and explain the LCP, they want what is best for their loved ones. Communication is absolutely vital.”