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The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial.

Costantini M, Ottonelli S, Canavacci L, Pellegrini F, Beccaro M, LCP Randomised Italian Cluster Trial Study Gro - BMC Health Serv Res (2011)

Bottom Line: Most cancer patients still die in hospital, mainly in medical wards.The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care.The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview".

View Article: PubMed Central - HTML - PubMed

Affiliation: Regional Palliative Care Network, National Cancer Research Institute, Genoa, Italy. massimo.costantini@istge.it

ABSTRACT

Background: Most cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now.

Methods and design: This is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit.The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview".

Discussion: This study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm. RESEARCH ID: RFPS-2006-6-341619

Trial registration: ClinicalTrials.gov Identifier: NCT01081899.

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Related in: MedlinePlus

Procedures of assesment for the eligible population.
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Figure 3: Procedures of assesment for the eligible population.

Mentions: For the two assessment periods (baseline and effectiveness assessment) all cancer patients deceased in the ward during the evaluation period will be considered eligible. ICD- IX criteria will be used to identify cases from the original death certificate. If the patient was a relative of a doctor or a nurse working in the hospital where the ward is located the patient will be considered ineligible.


The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial.

Costantini M, Ottonelli S, Canavacci L, Pellegrini F, Beccaro M, LCP Randomised Italian Cluster Trial Study Gro - BMC Health Serv Res (2011)

Procedures of assesment for the eligible population.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040703&req=5

Figure 3: Procedures of assesment for the eligible population.
Mentions: For the two assessment periods (baseline and effectiveness assessment) all cancer patients deceased in the ward during the evaluation period will be considered eligible. ICD- IX criteria will be used to identify cases from the original death certificate. If the patient was a relative of a doctor or a nurse working in the hospital where the ward is located the patient will be considered ineligible.

Bottom Line: Most cancer patients still die in hospital, mainly in medical wards.The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care.The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview".

View Article: PubMed Central - HTML - PubMed

Affiliation: Regional Palliative Care Network, National Cancer Research Institute, Genoa, Italy. massimo.costantini@istge.it

ABSTRACT

Background: Most cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now.

Methods and design: This is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit.The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview".

Discussion: This study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm. RESEARCH ID: RFPS-2006-6-341619

Trial registration: ClinicalTrials.gov Identifier: NCT01081899.

Show MeSH
Related in: MedlinePlus