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Under half of patients placed on end-of-life care pathway, say researchers

Less than half of patients nearing the end of their lives are placed on the Liverpool Care Pathway, indicating it may not be appropriate for all patients, report UK researchers.

The study

Researchers from Durham University searched the literature for studies of the Liverpool Care Pathway in order to analyse eligibility and uptake of the Pathway for any diagnosis/diagnoses and in any clinical or domiciliary setting. They identified 17 studies from between January 2005 and the end of July 2012 that provided information on the proportion of dying patients placed on the Liverpool Care Pathway. Three of the studies were conducted in other countries (Australia, Iceland and Holland) and the remaining 14 in the UK.

The findings

The majority of studies involved hospital/specialist care settings (13), with four involving hospices, three residential care homes and just one primary care. Overall, 47.4% of dying patients were placed on the Liverpool Care Pathway, the majority of whom (81%) had a cancer diagnosis. The proportion of eligible patients, i.e., entitled to be placed on the pathway due to their presenting symptoms, was not known. In the only study with sufficient available data, 236 (58%) of the total 407 patients were eligible for the pathway, but 79 (33%) died without being placed on it.

What this means for GPs

The authors say their findings ‘raise questions about clinicians’ levels of knowledge and awareness about the Liverpool Care Pathway, and the appropriateness and applicability of this pathway’. They add: ‘It is possible that clinicians are unconfident or unaware of the utility of the Liverpool Care Pathway, but equally possible that they deem the Liverpool Care Pathway to be inappropriate for patients for unknown reasons. More research is needed to examine the process of decision making when considering a patient for Liverpool Care Pathway delivery and about the quality of care experienced by those not placed on the pathway.’

BMJ Support Palliat Care 2013, online 4 June