Liverpool Care Pathway of "little benefit"
The Liverpool Care Pathway (LCP) is of “little benefit” to dying patients, a new randomised trial in Italy has found.
Researchers studied the effectiveness of the LCP-I, an Italian version of the LCP, in relation to cancer patients in 16 general medicine hospital wards across Italy.
They looked at the health records of over 300 cancer patients who died within six months of the beginning of the trial, in addition to speaking to their family members about their experiences, to measure the quality of care received on a scale of one to a hundred.
The study, published in the Lancet journal, revealed that LCP-I wards scored 70.5, whereas those with patients not on the scheme were given 63 out of 100. Some improvement was found in the areas of respect, dignity and kindness, and control of breathlessness, but no improvement was noted in survival time.
No meaningful difference
Researchers concluded that there was no "clinically meaningful" difference between the standard of care received by those placed on the programme and those who were not, stating that any end of life care initiative adopted in the future should be "grounded in scientific evidence."
Prof David Currow of Flinders University in Adelaide and Dr Amy Abernethy of Duke Clinical Research Institute in the USA said: "Across health care there is a need to improve care for people who are dying, which has led to widespread uptake of the LCP before adequate assessment.
"The results of the only adequately powered study of LCP so far have not shown clinically meaningful differences for patients — the ultimate measure of useful health policy."
Scientific evidence
Prof Irene Higginson, co-author of the study from 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."
The LCP was set up at the Royal Liverpool University Hospital and the city's Marie Curie hospice in the 1990 to care for and relieve the suffering of patients who are reaching the end of their lives.
Under fire
But the initiative came under fire last year after it was claimed that doctors were using it to hasten death, save money and clear hospital beds. There were also reports of food and hydration being withdrawn from dying patients without the knowledge and consent of their loved ones.
An independent review recommended that the LCP should be phased out “over the next 6 to 12 months” and replaced by personalised end of life care plans “backed up by good practice guidance specific to disease groups.”
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