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Nine out of 10 senior doctors would choose Liverpool care pathway for themselves

Criticism of Liverpool care pathway ‘putting end of life care back about twenty years’, doctors say

Ingrid Torjesen

Friday, 01 March 2013

The overwhelming majority (89%) of senior palliative care doctors believe the Liverpool care pathway (LCP) is the right approach for caring for patients in their final hours, and they would choose it for themselves, a joint BMJ and Channel 4 Dispatches survey has found.

Almost three quarters (74%) think that recent criticism of the LCP in the media and elsewhere has led to less use of the pathway. Of these, two-thirds (67%) said patients and relatives had asked them not to use it and 84% said staff were apprehensive about relatives’ complaints.

One specialist said the controversy around the LCP “has caused additional distress for relatives at an already distressing time when their loved one is dying.” Another said that it was “putting end of life care back about twenty years, where dying patients were hidden inside rooms and not seen by a consultant.”

The Liverpool care pathway was introduced to help doctors and nurses provide quality care for patients during their final hours and days of life, but it has recently been criticised after accounts of patients having food and fluids withdrawn and the use of financial incentives. Some families are claiming that their relatives could, and should, have lived longer. As a result, the Department of Health and the NHS National End of Life Care Programme are currently reviewing the pathway.

In February, in conjunction with Channel 4 Dispatches, the BMJ emailed 3,021 hospital doctors for an anonymous online survey. The results are based on answers from 563 doctors who responded and had used the pathway in their practice .The respondents include about 40% of all palliative medicine consultants in the UK.

Overall, 91% (514) thought that the pathway represented best practice for care of the dying patient, including 89% (164) palliative care specialists. If used properly, 98% (551) thought it allowed patients to die with dignity, with only two respondents (0.4%) disagreeing.

When asked if they would want the pathway during a terminal illness, 90% (509) said yes and 3% (16) said no. And despite media reports, almost all (98%) did not think that pressure on beds or other resources had influenced decisions to use the pathway.

However, only 13% (75) respondents agreed that hospitals should be offered financial incentives for using the pathway, with over half (58%) thought they should not.

Concerns about lack of training in the use of the pathway were also raised, in particular around recognising a dying patient and communicating this to patients and relatives.

The results can be seen on bmj.com and Death on the Ward: Channel 4 Dispatches (Monday 4 March, 8pm).

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