The effectiveness of the Liverpool Care Pathway in end of life care: a systematic review protocol

Abstract

Review question and objecticve The objective of this review is to present the best available evidence related to the implementation of the Liverpool Care Pathway in end of- life care in the hospital setting. The specific questions to be addressed are as follows: What is the effectiveness of the Liverpool Care Pathway on the quality of life (QoL) of the dying patient? 2. What is the effectiveness of the Liverpool Care Pathway on the quality of end of life care in the dying patient? More specifically, questions to be explored informing the quality of end of life care will include: What is the effectiveness of the Liverpool Care Pathway on symptom management and physical severity of symptoms in the dying patient? What is the effectiveness of the Liverpool Care Pathway on the communication between healthcare professionals, patients and their families? Inclusion criteria Types of participants This review will consider studies that include adult patients, 18 years of age and over, at the end stage of life in the hospital setting. The end stage of life is defined as a phase of life when a person is living with an illness that will worsen and eventually cause death, or from a point at which it becomes clear that the patient is in a progressive state of decline towards death. Inclusion will be independent of diagnosis. The review will also consider studies that include health care professionals providing care to dying patients in the hospital setting, caregivers and the families of patients at the end stage of life. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the use of the LCP in end of life care. Where comparative studies are located, use of the LCP will be compared with usual care (where no pathway is used). Studies evaluating other integrated pathways of care for the dying, or comparing LCP to another pathway of care will be excluded. Types of outcomes The primary outcomes of interest are: - The QoL of the dying patient, measured by validated instruments designed for use in this population including the McGill Quality of life Questionnaire 22 and Quality of life at end of life (QUAL-E) scale. 23 - Assessment of the quality of end of life care will include any instruments designed for this purpose; for example, items of the toolkit “ After death bereaved family member interview ” and other similar validated measurement instruments. 24 - Symptom management/ severity in the dying patient including pain, nausea/vomiting, agitation and respiratory secretions. Acceptable measures will include those using instruments such as The European Organisation for Research and Treatment of Cancer, Quality of Life of Cancer patients (EORTC QLQ-C30), 25 The National Institute for Clinical Excellence (NICE) guideline 7 - Quality of communication between healthcare professionals, patients and families. This is commonly established with items from the Views of Informal Carers- Evaluation of Service (VOICES) questionnaire. The VOICES is an instrument specifically developed for proxies to evaluate the care and services received by patient and their relatives in the last months of the patient’s life. 26 The secondary outcomes of interest will be patient/staff satisfaction with the provision of care and any noted adverse events attributable to the use of the LCP, for example over sedation or under nutrition in patients.