Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Freemantle Alison; Seymour Jane (2012)
Publisher: BioMed Central
Journal: BMC Research Notes
Languages: English
Types: Article
Subjects: Liverpool care pathway, Medicine, QH301-705.5, Biochemistry, Genetics and Molecular Biology(all), R, Medicine(all), Cancer, Short Report, Qualitative research, Hospital, Healthcare professionals, Biology (General), End-of-life care



Despite evidence suggesting that the Liverpool Care Pathway for the Dying Patient is a structured and proficient means of supporting care delivery in the last hours or days of life, discrepancies in uptake are widespread. This exploratory study sought to understand why patients dying of cancer in oncology wards of one hospital trust were, or were not, supported by the LCP. A purposive qualitative case study design was used; each case represented a patient who had died and their most involved nurse and doctor. In-depth interviews explored both recollections of the ‘case’ and wider experiences of using the Pathway in end-of-life care. Eleven healthcare professionals were interviewed about their involvement in the end-of-life care of six patients. For four of these patients care was supported by the LCP.


Although doctors and nurses reported they preferred to use the Pathway to ensure comfortable death, an important factor influencing their decisions was time of death. Access to timely senior review was regarded as an essential preliminary to placing patients on the Pathway but delayed access ‘out of hours’ was commonly experienced and tensions arose from balancing conflicting priorities. Consequently, the needs of dying patients sometimes failed to compete with those receiving curative treatment.


This study suggests that greater attention should be focused on ‘out of hours’ care in hospitals to ensure regular senior review of all patients at risk of dying and to support front line staff to communicate effectively and make contingency plans focused on patients’ best interests.

  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Davies E, Higginson IJ: Palliative care: the Solid Facts. [http://www.euro.who. int/__data/assets/pdf_file/0003/98418/E82931.pdf].
    • 2. Ellershaw JE, Wilkinson S: eds: Care of the Dying: A pathway to excellence. Oxford: Oxford University Press; 2003.
    • 3. Jack B, Gambles M, Murphy D, Ellershaw J: Nurses' perceptions of the Liverpool Care Pathway for the dying patient in the acute hospital setting. Int J Palliat Nurs 2003, 9:375-381.
    • 4. Walker R, Read S: The Liverpool Care Pathway in intensive care: an exploratory study of doctor and nurse perceptions. Int J Palliat Nurs 2010, 16:267-273.
    • 5. Di Leo S, Beccaro M, Finelli S, Borreani C, Costantini M: Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital. Palliat Med 2011, 25:293-303.
    • 6. O' Hara T: Nurses' views on using the Liverpool Care Pathway in an acute hospital setting. Int J Palliat Nurs 2011, 17:239-244.
    • 7. Mullick A, Beynon T, Colvin M, Morris M, Shepherd L, Cave L, Lowell J, Asmall N, Carey I: Liverpool care pathway carers survey. Palliat Med 2009, 23:571-572.
    • 8. Veerbeek L, Zuylen L, Swart S, van der Mass P, de Vogel-Voogt E, van der Rijt C, van der Heide A: The effect of the Liverpool Care Pathway for the Dying: a multi-centre study. Palliat Med 2008, 22:145-151.
    • 9. Veerbeek L, van de Heide A, de Vogel-Voogt E, Bakker R, van der Rijt C, Swart S, van der Maas P, Zuylen L: Using the LCP: Bereaved Relatives' Assessments of Communication and Bereavement. Am J Hosp Palliat Care 2008, 25:207-214.
    • 10. National Institute for Clinical Excellence: Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer. London: NICE; 2004.
    • 11. Murphy D: The Liverpool Care Pathway provides clarity and focus; communication, care and compassion come from you. Int J Palliat Nurs 2011, 17:529.
    • 12. Marie Curie Palliative Care Institute Liverpool: National Care of the Dying Audit -Hospitals (NCDAH) Round 3. 2011 [http://www.mcpcil.org.uk/media/ livacuk/mcpcil/documents/NCDAH-GENERIC-REPORT-2011-2012-FINAL.doc17.11.11.pdf].
    • 13. Fowell A, Finlay I, Johnstone R, Minto L: An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care. Int J Palliat Nurs 2002, 8:566-572.
    • 14. Mirando S, Davies P, Lipp A: Introducing an integrated care pathway for the last days of life. Palliat Med 2005, 19:33-39.
    • 15. Hardy J, Haberecht J, Maresco-Pennis D, Yates P: Audit of the care of the dying in a network of hospitals and institutions in Queensland. Intern Med J 2007, 37:315-319.
    • 16. Lo S, Chan C, Chan C, Sze W, Yuen K, Wong C, Ng T, Tung Y: The implementation of an end-of-life integrated care pathway in a Chinese population. Int J Palliat Nurs 2009, 15:384-388.
    • 17. Stake R: Qualitative Case Studies. In The Sage Handbook of Qualitative Research. Edited by Denzin N, Lincoln Y. London: Sage; 2005.
    • 18. Crabtree BF, Miller WL: Using Codes and Code Manuals: A Template Organising Style of Interpretation. In Doing Qualitative Research. 2nd edition. Edited by Crabtree BF, Miller WL. London: SAGE Publications Inc; 1999:163-177.
    • 19. Raijmakers N, Zuylen L, Costantini M, Caraceni A, Clark J, De Simone G, Lundquist G, Voltz R, Ellershaw J, Van der Heide A: Issues and needs in end-of-life decision making: an international modified Delphi study. Palliat Med 2011, XX:1-7.
    • 20. Cooper H, Findley G, Goodwin A, Gough M, Lucas S, Mason D, Mason M, Martin I, Stewart J, Wilkinson K: NCEPOD Deaths in Acute Hospitals: Caring to the End? 2009 [http://www. endoflifecareforadults.nhs.uk/. . ./deaths-inacute-hospitals-caring-to-the-end].
    • 21. Pugh E, McEnvoy M, Blenkinsopp J: Use of the proportion of patients dying on an End of Life Pathway as a quality marker: considerations for interpretation. Palliat Med 2010, 24:544-547.
  • No related research data.
  • No similar publications.