Controversial Liverpool Care Pathway is of little benefit for dying patients, major study finds

  • Study compared care provided under the Italian version of the LCP and hospitals that do not implement the program as end of life care in Italy
  • Found 'no significant differences' in quality of care between the wards
  • Suggested that any initiative to replace the LCP in England should be 'grounded in scientific evidence' before it is implemented

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The study rated key aspects of care including support for families and control of symptoms breathlessness (posed by model)

The study rated key aspects of care including support for families and control of symptoms breathlessness (posed by model)

The controversial Liverpool Care Pathway has little clinical benefit for dying patients, according to a major new trial.

Based on findings published in The Lancet, the researchers suggest that any initiative to replace the Liverpool Care Pathway (LCP) in England should be 'grounded in scientific evidence' and tested in controlled trials before it is implemented.

The LCP was jointly developed by the Marie Curie Hospice Liverpool and the Royal Liverpool University Hospital in the late 1990s with the aim of rolling out the best practice of hospices to hospitals, to provide uniform, high-quality, dignified care for dying patients in the last days or hours of life.

However, its effectiveness for improving care for the dying has not been assessed in a randomised trial until now.

In the study, The Liverpool Care Pathway Italian Cluster Trial Study Group assessed the impact of the Italian version of the LCP (LCP-I) on the quality of care of adult patients dying with cancer and their families in 16 general medicine hospital wards across Italy.

Wards and palliative care teams chosen at random, were trained in the LCP-I programme or to follow standard healthcare practice.

Bereaved family members of cancer patients were interviewed within four months of their relative's death, and the quality of end-of-life care assessed using a scale of 0 to 100.

 

They rated key aspects of care including information and decision-making, co-ordination of care, support for families, and control of symptoms such as pain and breathlessness.

No significant differences in the overall quality of care between the wards in which the LCP-I was implemented and the control wards was noted. 

And two dimensions assessed - respect, dignity, and kindness and control of breathlessness - also showed some improvement in the LCP-I wards.

No significant differences in the overall quality of care between the wards in which the Italian version of the LCP was implemented and the control wards was noted

No significant differences in the overall quality of care between the wards in which the Italian version of the LCP was implemented and the control wards was noted

However, no differences in survival times between patients in LCP-I and control wards were noted.

Study leader Dr Massimo Costantini said: 'Although we found no significant difference in overall quality of care for those on the LCP-I ward, we did see a small improvement.

This could indicate that the LCP-I may have the potential to close the gap between hospice care and hospital care as we know families rate quality of hospice care more highly.

While the results of this trial should be interpreted with caution because there were slightly fewer participants than expected, and we observed some variability in implementation of the LCP between the hospitals, this is a robust trial and the findings should be used to inform strategies to care for dying patients. 

'There could be fundamental components of the LCP that might be beneficial, and the next steps are to establish this.'

Professor Irene Higginson, co-author of the study and Director of the Cicely Saunders Institute at King's College London, said: 'Our findings demonstrate just how important it is for any initiative that replaces the LCP in England to be grounded in scientific evidence and tested in controlled trials before being rolled out across the board.

'We must face this challenge head-on and ensure scientific evidence forms the foundations for any new initiative if end-of-life care is to be genuinely improved for patients and their families in England.'

Commenting on the findings, David Currow, of Flinders University in Australia, and Amy Abernethy, from Duke Clinical Research Institute in the USA, said: 'Across healthcare there is a need to improve care for people who are dying, which has led to widespread uptake of the Liverpool Care Pathway before adequate assessment.

'A decade after widespread uptake, the results of this, the only adequately powered study of LCP so far have not shown clinically meaningful differences for patients - the ultimate measure of useful health policy.'

The comments below have not been moderated.

It was never of benefit to the patient was it? The hospitals were being paid bonuses for bumping them off!!

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The LCP is put into practice when a patient is no longer able to eat, drink or take their medicines ...a syringe driver will be set up to infuse that patients much needed meds I,e pain relief over a 24 hr period. (So they do not die in pain, agitation or any other discomfort) our families are always informed and their permission sought before their loved one is commenced on a LCP. Indeed this is always discussed with our patients before they fall too poorly. we do not starve or deprive patients of care. And we certainly did not get bonuses for placing them on it.

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Enough!! It's being abandoned, and whether that's because it was abused by a small percentage of health care professionals, or whether it was due to the hysteria caused by this "news" paper is now a moot point. I just hope that hospitals aren't now so scared of being the victims of another witch-hunt that they leave people to die in agony, without any rights, and slowly.

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We can help dying people without speeding their deaths by withdrawing fluid.that can't be nice and will not be allowing that to happen to me or those I love.

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People really need to do research before they spout opinions. The LCP in good practice is a good framework, helps the dying person end their life in the most comfortable & pain free way, allowing the care provider an ease of getting the things needed quicker because of it, because as some will be aware, getting a gp/nurse can sometimes take days!

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Before making stupid comments about the LCP "starving" patients and "killing or euthanising" patients I suggest that you carry out some PROPER research into the LCP. That means from proper academic sources NOT the DM's biased and inaccurate interpretation of it.

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The left are the only political persuasion cruel enough to introduce such a barbaric practice of starving someone to death under the banner of being kind.

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It really annoys me when people comment when they obviously have no knowledge of the LCP what so ever!!! If you understood what the LCP aims to achieve then you would know that nobody on it is 'starved'!! All it aims to do is make a person who is ALREADY dying more comfortable in their final days by withdrawing unnecessary treatment. Nowhere in the LCP does it say not to feed a patient. This would only happen if feeding them was doing more harm than good e.g when that person is too drowsy to eat. What most people don't realise is that with or without the LCP care of the dying remains exactly the same.

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From my experience when a very close friend died from cancer both fluid and foods were withheld for 5days. I felt shocked at the time and had no idea that the process was the LCP. I'm sorry but my interpretation of this situation is that the patient was starved.

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I have seen people on LCP and also seen people live 4 years later! It is used in the wrong context sometimes. People may have a poor prognosis but does not mean they will die in 6 weeks. That is the problem we should be looking at how long life can be prolonged and not the inevitable

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I wonder how long this would have carried on if there hadn't been an outcry.....the people who introduced the Liverpool pathway, I wonder if they would have been happy to be treated by this method of care, I very much doubt it. To remove the basic comforts of people in their final hours is a complete disgrace and allows people to play god.

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