Palliative care after the Liverpool Care Pathway: a study of staff experiences
The objective of this study was to explore nurses' perceptions of end-of-life care following the withdrawal of the Liverpool Care Pathway (LCP). Thirteen semi-structured interviews were conducted with nurses working in palliative care. Data were analysed using thematic analysis. Three themes emerged: perceptions of the LCP, prevailing issues, and patients' and families' experiences. This study suggested that the removal of the pathway has not remedied the issues attributed to it. Further, the way in which the LCP was removed indicates that the non-expert media can play a negative role in how palliative care is perceived, which inhibits the care process. In this respect it is important that ‘insider’ voices are also heard, in order to educate and also redress disinformation. Similarly, broader, persisting, contextual challenges facing staff need addressing in order to prevent a repeat of the issues leading to the removal of the LCP.
The Liverpool Care Pathway (LCP) was promoted as a care pathway that aimed to ensure minimum standards of care to all terminally ill patients (Ellershaw and Wilkinson, 2011). It was supported and endorsed by both the Department of Health (DH) (2002)and the National Institute for Health and Care Excellence (NICE) (2004) as the gold standard in palliative care settings (Sprung et al, 2003). However, the media developed an alternative narrative whereby the LCP was portrayed as a ‘death pathway’ (Martin, 2009 and, similarly, a ‘pathway to death’ used ‘to hasten deaths to save the NHS money and free up beds’ (Rawstorne, 2012). Such adverse reporting and the resultant rise in public concern (NHS website, 2012) culminated in a review of the LCP, which highlighted concerns relating to dehydration, malnutrition, unnecessary opioid usage and a lack of family involvement (Neuberger et al, 2013). As a response to this, the DH commissioned the Leadership Alliance for Care of Dying People (LACDP) to make recommendations in the form of the published guidance: One Chance to Get it Right (LACDP, 2014). The initial priority was to phase out the LCP by July 2014.
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