Abalos EE., Rivera RY, Locsin RC, Schoenhofer SO. Husserlian phenomenology and Colaizzi's method of data analysis: exemplar in qualitative nursing inquiry using nursing as caring theory. International Journal of Human Caring. 2016; 20:(1)19-23

Birt L, Scott S, Cavers D, Campbell C, Walter F. Member checking: a tool to enhance trustworthiness or merely a nod to validation?. Qual Health Res. 2016; 26:(13)1802-1811

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3:(2)77-101

Chinthapalli K. The Liverpool care pathway: what do specialists think?. BMJ. 2013; 346

Converse M. Philosophy of phenomenology: how understanding aids research. Nurse Res. 2012; 20:(1)28-32

Craig JV, Smyth RL. The evidence based practice manual for nurses.Edinburgh: Churchill Livingstone; 2007

Dee JF, Endacott R. Doing the right thing at the right time. J Nurs Manag. 2011; 19:(2)186-192

Independent health care national minimum standards.London: Department of Health; 2002

Ellershaw J, Wilkinson S. Care of the dying: a pathway to excellence, 2nd edn. Oxford: Oxford University Press; 2011

Gambles M, Stirzaker S, Jack BA, Ellershaw JE. The Liverpool Care Pathway in hospices: an exploratory study of doctor and nurse perceptions. Int J Palliat Nurs. 2006; 12:(9)414-421

Gambles MA, McGlinchey T, Aldridge J, Murphy D, Ellershaw JE. Continuous quality improvement in care of the dying with the Liverpool Care Pathway for the dying patient. International Journal of Care Pathways. 2009; 13:(2)51-56

George R, Martin J, Robinson V. The Liverpool Care Pathway for the dying (LCP): lost in translation and a tale of elephants, men, myopia—and a horse. Palliat Med. 2014; 28:(1)3-7

Holloway I, Wheeler S. Qualitative research in nursing and health care, 3rd edn. Oxford: Wiley-Blackwell; 2010

Jack BA, Gambles M, Murphy D, Ellershaw JE. Nurses' perceptions of the Liverpool Care Pathway for the dying patient in the acute hospital setting. Int J Palliat Nurs. 2003; 9:(9)375-381

Larkin M, Thompson AR. Interpretative phenomenological analysis in mental health and psychotherapy research. In: Harper D, Thompson AR (editors). London: John Wiley and Sons; 2011

Leadership Alliance for the Care of Dying People. One chance to get it right: improving people's experience of care in the last few days and hours of life. 2014. (accessed 18 July 2019)

Euthanasia by the back door: hospitals' ‘death pathway’ is open to error. 2009. (accessed 18 July 2019)

National Institute for Health and Care Excellence. Improving supportive and palliative care for adults with cancer. 2004. (accessed 18 July 2019)

National Institute for Health and Care Excellence. Care of dying adults in the last days of life. NICE guideline NG31. 2015. (accessed 18 July 2019)

More care, less pathway: a review of the Liverpool care pathway. 2013. (accessed 18 July 2019)

NHS website. News analysis: what is the Liverpool care pathway?. 2012. (accessed 18 July 2019)

O'Hara T. Nurses' views on using the Liverpool care pathway in an acute hospital setting. Int J Palliat Nurs. 2011; 17:(5)239-244

O'Leary Z. The essential guide to doing research.London: Sage; 2005

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015; 42:(5)533-544

Rapid evidence review: pathways focused on the dying phase in end of life care and their key components. 2013. (accessed 23 July 2019)

Picton CJ, Moxham L, Patterson C. The use of phenomenology in mental health nursing research. Nurse Res. 2017; 25:(3)14-18

Ramasamy Venkatasalu M, Whiting D, Cairnduff K. Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life care. J Adv Nurs. 2015; 71:(9)2108-2118

My diary of mum's awful death on the Liverpool care pathway: nurse's heart-rending account of how doctors decided to put her mother on ‘pathway to death’. 2012. (accessed 18 July 2019)

Regnard C. The demise of the Liverpool Care Pathway: should we ban the highway code because of bad drivers?. Age Ageing. 2014; 43:(2)171-173

Seymour J, Clark D. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England. Wellcome Open Res. 2018; 3

Silverman D. Qualitative research.London: Sage; 2011

Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: Theory, method and research.London: Sage; 2009

Smith JA, Osbourne M. Interpretative phenomenological analysis, 2nd edn. In: Smith JA (ed). London: Sage; 2008

South Tees Hospitals NHS Foundation Trust. Care plan for the last days of life: person centred initial holistic nursing assessment. (accessed 30 July 2019)

Sprung CL, Cohen SL, Sjokvist P End-of-life practices in European intensive care units: the Ethicus study. JAMA. 2003; 290:(6)790-797

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19:(6)349-357

Twigger S, Yardley SJ. Hospital doctors' understanding of use and withdrawal of the Liverpool Care Pathway: a qualitative study of practice-based experiences during times of change. Palliat Med. 2017; 31:(9)833-841

Veerbeek L, van Zuylen L, Swart SJ The effect of the Liverpool Care Pathway for the dying: a multi-centre study. Palliat Med. 2008; 22:(2)145-151

Walker R, Read S. The Liverpool Care Pathway in intensive care: an exploratory study of doctor and nurse perceptions. Int J Palliat Nurs. 2010; 16:(6)267-273

Palliative care after the Liverpool Care Pathway: a study of staff experiences

08 August 2019
Volume 28 · Issue 15


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.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content