Care Pathways do they make a difference? Nurses perceptions of the impact of the Liverpool Care of the Dying Pathway in the acute hospital setting

Background: The last decade has seen the widespread development of care pathways in many areas of healthcare provision across the UK. Approximately 56% of cancer patients die in hospital and in order to transfer the hospice model of care for the dying patient into other settings, the Liverpool Care of the Dying Pathway (LCP) was developed. (Ellershaw and Wilkinson, 200�). This mulitprofessional pathway provides an evidence based framework for the dying phase. Providing guidance on the different aspects of care required including: comfort measures, anticipatory prescribing of medication, and discontinuation of inappropriate interventions. Additionally psychological and spiritual care and family support is included. However, little evidence exists to illustrate the views of nurses regarding the impact of the LCP. The aim of this study was to explore nurses’ perceptions of the impact of the LCP in the acute hospital setting. Methodology: A qualitative methodology using focus group interviews was adopted for the study to enable group discussion and interaction to take place (Bloor et al 2001, Vaughn et al 1996). A purposive sample of palliative care network nurses familiar with the LCP were invited to participate in the study. 15 ward based nurses from across the hospital participated in two audio taped focus groups. Data was analysed for emerging themes using thematic analysis. Results and Discussion: The results suggest that generally nurses have found the LCP has a positive impact on patients including reducing inappropriate routine care, enhanced symptom control, and improved communication for relatives. Additionally participants reported the positive impact on doctors and nurses including increased confidence in their care of dying patients. A potentially negative factor concerning the barriers to its usage was also highlighted. This paper discusses the results and explores potential reasons for the findings.