The Liverpool Care Pathway: discarded in cancer patients but good enough for dying nursing home patients? A systematic review

BMC Medical Ethics

Research Article

Bettina S. Husebø¹  Elisabeth Flo²  Knut Engedal³ 

[1] Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Bergen Municipality, Bergen, Norway;Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Department of Clinical Psychology, University of Bergen, Bergen, Norway;Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Vestfold hospital and Oslo universitet hospital, Ullevaal, Oslo, Norway;

关键词: Nursing Home;    Liverpool Care Pathway;    Dementia;    Geriatric;    Decision-making;    End-of-Life-care;    Reliability;    Validity;    Responsiveness;   

DOI  :  10.1186/s12910-017-0205-x

 received in 2016-11-28, accepted in 2017-07-16,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe Liverpool Care Pathway (LCP) is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for dying people with dementia.MethodsThis systematic review is based on a systematic literature search of MEDLINE, CINAHL, EMBASE, and Web of Science.ResultsThe search identified 12 studies, but none describing an evidence-based adaption of LCP to nursing home patients and people with dementia. No studies described the LCP implementation procedure, including strategies for discontinuation of medications, procedures for nutrition and hydration, or the testing of such procedures in nursing homes. No effect studies addressing the assessment and treatment of pain and symptoms that include dying nursing home patients and people with dementia are available.ConclusionLCP has not been adapted to nursing home patients and people with dementia. Current evidence, i.e. studies investigating the validity and reliability in clinically relevant settings, is too limited for the LCP procedure to be recommended for the population at hand. There is a need to develop good practice in palliative medicine, Advance Care Planning, and disease-specific recommendations for people with dementia.

【 授权许可】

CC BY   
© The Author(s). 2017