Palliative specialists support UK care pathway

Mar 6 2013

By Sarah Guy, medwireNews Reporter

An overwhelming majority of UK doctors believe that the Liverpool care pathway (LCP) represents the best practice for care of a dying patient, according to an email survey with over 600 respondents.

A similarly high number of doctors indicated that they would want the pathway themselves if they were terminally ill, show the results.

"The Liverpool care pathway is the most widely used integrated care pathway for end of life care, but it has recently been criticised after accounts in the media of patients having food and fluids withdrawn and hospitals being offered financial incentives for using the pathway," writes Krishna Chinthapalli (British Medical Journal [BMJ], London, UK) in the BMJ.

The journal emailed 3021 hospital doctors to gauge their views of the care pathway, which engages a multidisciplinary team to assess whether a patient is indeed dying, and to consider and agree on palliative care options, including whether nonessential treatments and medications should be discontinued.

Of the 647 respondents, 185 were palliative medicine consultants, 168 were doctors in training or career grade posts in palliative medicine, and 210 were doctors of other specialties. A total of 87% reported having used the LCP in clinical practice.

However, 57% of respondents felt that recent negative press in the UK media has led to the care pathway being used less. Almost three-quarters (74%) of palliative medicine specialists felt this way. Indeed, 60% of doctors who believed there was less use of the pathway as a result of a negative perception in the UK media said that relatives of dying patients had asked them not to use it, and that 80% of staff were apprehensive about it.

One palliative medicine specialist said: "Negative press regarding the LCP has caused additional distress for relatives at an already distressing time when their loved one is dying. This has caused a dilemma in judging if discussing the LCP will cause more distress than the benefit of being on the LCP."

Notably, 90% of doctors said that they would want the pathway themselves during a terminal illness, although the questionnaire did not make it clear whether that meant dying from a terminal illness.

That the pathway precludes nutrition, hydration, and antibiotics are "damaging misconceptions" said specialists, as well as the idea that it is a "one way process with no further patient review."

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