Silvia Di Leo1, Vittoria Romoli2, Irene J Higginson3, Francesco Bulli4, Susanna Fantini5, Erica Sguazzotti6, Massimo Costantini7. 1. Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy Silvia.DiLeo@asmn.re.it. 2. Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy. 3. King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK. 4. Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy. 5. Istituto di Tanatologia e Medicina Psicologica, Bologna, Italy. 6. Departments of Mental Health and Clinical and Biological Sciences, University of Turin, Turin, Italy Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy. 7. Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Abstract
BACKGROUND: Despite being widely used, research into the effectiveness of the Liverpool Care of the Dying Pathway (LCP) and associated cases of malpractice does not match dissemination. No study exists focusing on concerns voiced by professionals. AIM: To explore the views of professionals who, during the hospital implementation of the Italian version of the Liverpool Care of the Dying Pathway (LCP-I), voiced or showed concerns towards it. DESIGN: A qualitative study nested within the LCP-I randomized cluster trial, with semi-structured interviews analysed using thematic analysis. SETTING AND PARTICIPANTS: Six nurses and five physicians from six out of the eight hospital wards who completed the LCP-I implementation were interviewed. Eligibility criteria were having taken part in all steps of the LCP-I Programme, voiced or somehow shown concerns, or failed to fully engage with the implementation process. RESULTS: A total of 12 categories were identified, referring to four topics: the Implementation Programme, the LCP-I clinical documentation, the hospital environment and the educational and professional background of hospital healthcare staff. Issues raised by participants concerned both 'real' characteristics of the LCP-I and a misinterpretation of the LCP-I approach and clinical documentation. Furthermore, difficulties were reported which were not linked to the Programme but rather to end-of-life care. CONCLUSION: This study provides insights into the experience of professionals with negative opinions of or concerns with the LCP-I. A more comprehensive approach to professional training in palliative care is needed and may envisage the development of new interventions aimed at improving the quality of care throughout the illness trajectory.
BACKGROUND: Despite being widely used, research into the effectiveness of the Liverpool Care of the Dying Pathway (LCP) and associated cases of malpractice does not match dissemination. No study exists focusing on concerns voiced by professionals. AIM: To explore the views of professionals who, during the hospital implementation of the Italian version of the Liverpool Care of the Dying Pathway (LCP-I), voiced or showed concerns towards it. DESIGN: A qualitative study nested within the LCP-I randomized cluster trial, with semi-structured interviews analysed using thematic analysis. SETTING AND PARTICIPANTS: Six nurses and five physicians from six out of the eight hospital wards who completed the LCP-I implementation were interviewed. Eligibility criteria were having taken part in all steps of the LCP-I Programme, voiced or somehow shown concerns, or failed to fully engage with the implementation process. RESULTS: A total of 12 categories were identified, referring to four topics: the Implementation Programme, the LCP-I clinical documentation, the hospital environment and the educational and professional background of hospital healthcare staff. Issues raised by participants concerned both 'real' characteristics of the LCP-I and a misinterpretation of the LCP-I approach and clinical documentation. Furthermore, difficulties were reported which were not linked to the Programme but rather to end-of-life care. CONCLUSION: This study provides insights into the experience of professionals with negative opinions of or concerns with the LCP-I. A more comprehensive approach to professional training in palliative care is needed and may envisage the development of new interventions aimed at improving the quality of care throughout the illness trajectory.