End of life care for all: Palliative Care in the Intensive care unit

One of the challenges facing palliative care is to transfer best practice of care for the dying from a hospice setting to other care settings, and to non-cancer patients. One tool for achieving this is the Liverpool Integrated Care Pathway for the Dying Patient (LCP). This is a multi-professional document that incorporates evidence-based practice and appropriate guidelines related to care of the dying. The LCP has been developed for the care of the dying cancer patient, but with modifications can be used in non-cancer patient populations. Aim Patients on the Intensive Care Unit (ICU) have a high mortality rate and many patients with advanced illnesses spend some time ICU during their final hospital admission. We carried out an action research project with the aim of producing a revised LCP, designed specifically for use on ICU. Method and Results: Two focus group interviews were carried out in order to gain an insight of how staff from a busy, adult ICU felt dying patients were cared for, the relevance of the LCP in its current format and suggestions for modification. A thematic analysis of findings was undertaken. Key findings included the opinion that care of the dying could be improved, particularly around diagnosing dying. There was strong support for LCP use in an amended form. A working group, made up of members of the ICU and hospital palliative care teams, used these findings to amend the LCP. After further consultation, the new LCP was launched on ICU with an accompanying teaching programme run by the palliative care team. Completed LCPs were analysed after the project and compared with a base review of documentation carried out previously. Conclusion: This demonstrates how palliative care can cross the borders into intensive care, and provides a model fo