Tracey McConnell1, Peter O'Halloran1, Michael Donnelly2, Sam Porter1. 1. School of Nursing and Midwifery, Queen's University, Belfast, UK. 2. School of Medicine, Dentistry and Biomedical Sciences, Centre of Excellence for Public Health, Belfast, UK.
Abstract
OBJECTIVES: The Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation. METHOD: An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semistructured interviews were conducted with two policymakers and 22 participants with experience and/or involvement in management of the LCP during 2011 and 2012. RESULTS: Key resource inputs included facilitation with a view to maintaining LCP 'visibility', reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy, and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care. CONCLUSIONS: There is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: The Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation. METHOD: An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semistructured interviews were conducted with two policymakers and 22 participants with experience and/or involvement in management of the LCP during 2011 and 2012. RESULTS: Key resource inputs included facilitation with a view to maintaining LCP 'visibility', reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy, and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care. CONCLUSIONS: There is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Kate M Lillie; Lisa G Dirks; J Randall Curtis; Carey Candrian; Jean S Kutner; Jennifer L Shaw Journal: J Transcult Nurs Date: 2019-07-01 Impact factor: 1.959
Authors: Naouma Siouta; K Van Beek; M E van der Eerden; N Preston; J G Hasselaar; S Hughes; E Garralda; C Centeno; A Csikos; M Groot; L Radbruch; S Payne; J Menten Journal: BMC Palliat Care Date: 2016-07-08 Impact factor: 3.234
Authors: J Gilissen; L Pivodic; C Gastmans; R Vander Stichele; L Deliens; E Breuer; L Van den Block Journal: BMC Geriatr Date: 2018-02-14 Impact factor: 3.921
Authors: Maha Pervaz Iqbal; Elizabeth Manias; Laurel Mimmo; Stephen Mears; Briony Jack; Liz Hay; Reema Harrison Journal: BMC Health Serv Res Date: 2020-10-15 Impact factor: 2.655