The Liverpool Care Pathway was designed to ease the final days of the dying and reduce unnecessary medical interventions.
However, the UK has now withdrawn the program after an audit found fewer than half of patients were being told they were dying, many were forgotten on weekends and that some patients were denied food, water and pain relief.
In Australia, where the Liverpool Care Pathway (LCP) is still used, medical staff are faced with a dilemma.
A report in the Medical Journal of Australia says the program is in widespread use across acute care hospitals and residential aged care facilities in Australia.
The program designed in the 1990s defined 18 goals of care relating to comfort, psychological and insight concerns, religious and spiritual support, communication with family and primary health-care teams, and care after death.
It rapidly evolved from a local solution to a local problem into a national program promoted by the UK’s National Health Service and adopted by more than 1,800 health care institutions, without a sufficiently robust evaluation of its effectiveness.
Dr Raymond Chan, a nurse researcher at the Royal Brisbane and Women’s Hospital’s Cancer Care Services, and his co-authors wrote that the UK’s decision to withdraw the program as a result of an adverse independent review created an urgent need for research in Australia.
“The lack of high-quality health services research before widespread implementation of the LCP has created a dilemma for Australia: do the adverse findings [of the UK’s independent review] apply to Australia and, if so, to what extent?” the authors wrote.
The UK review found the program was often associated with poor care and poor diagnosis of dying in clinical care, as well as ethical, safety, clinical practice and legal problems.
“Although the intention and end-of-life care principles underpinning the LCP are sound, use of the pathway has extended well beyond the evidence base”, the authors wrote.
Australian researchers need to establish whether the outcomes for dying patients placed on an end of life plan are different to those receiving usual care.
The UK review mainly showed that the program was not being followed.
“We urge policymakers to continue to invest in building the palliative care capabilities of the Australian health care workforce”, the Australians write in the Medical Journal of Australia.
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