Liverpool Care Pathway (LCP)

Poll

Is it the right decision to scrap the LCP?

The LCP is set to be scrapped after it has been claimed that it is being used to free up bed space and cut costs. I feel that the LCP has been misrepresented in the media recently but I wanted to know if anyone on here had had any experiences of the LCP and was willing to share them? Also do you agree with the LCP being scrapped?

Reply 1

Pigling

The way the media have handled the LCP is appalling and has caused serious harm.

If it is scrapped it must be replaced with an equivalent.

Reply 2

carriesouthcott

Original post by Whey aye Cabaye

I've had no actual experience of it but its something that has worried me ever since my disabled child was placed under the palliative care team 5 years ago. Although he'll never get better (brain damage) he has an excellent quality of life and I would absolutely want everything possible to be done for him if he was to become critically ill.

There are far too many instances of care being withdrawn without family consent by medical staff who only see the current situation not what the individual is like at his or her best.

If a family member of mine had deteriorated to a point in which they were not going to survive I certainly wouldn't want them to die through dehydration or malnutrition. It is inhuman and I welcome its abolishment.

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Reply 3

Isengard

There's nothing wrong with managing old people into death, they're pretty close to dying anyway so put them out their misery rather than requiring them to hang around like a bag of bones. The care pathway doesn't go far enough.

Reply 4

Pigling

Original post by carriesouthcott

If a family member of mine had deteriorated to a point in which they were not going to survive I certainly wouldn't want them to die through dehydration or malnutrition. It is inhuman and I welcome its abolishment.

It is unfortunate you have come away with this impression of the LCP / palliative care.

Neither are about ending an individual's life, and the involvement of palliative care does not mean other medical teams have "given up" or won't try as hard to prolong someone's life if it is the right thing to do. Or that consultation with relatives has ended.

They are about ensuring someone who is or may be at the end of life, is comfortable, symptoms particularly associated with end-of-life are controlled, that procedures which are cruel and importantly futile are not carried out.

In addressing concerns about food and drink - in palliative care / LCP, individual's are not deprived of eating and drinking. In fact, the LCP may theoretically enable someone to have the comfort of oral foods and drink; whereas otherwise they're risk of aspiration might be considered too high.

In fact, most people in the very terminal phase of their life, tend to lose an interest in food and drink. Without the LCP, what doctors might have to do is force them to eat and drink, by inserting uncomfortable tubes into their stomach and veins. This may be futile (it will not prolong their life) and cruel in 2 ways: A) the discomfort of the tubes themselves, B) in the terminal phase the fluid balance of the body, and the function of the gut becomes deranged. A dying person's body may put too much fluid into their stomach and airways, causing them to bubble at the throat/ have respiratory discomfort; and food/fluid in the gut may do very little but cause nausea. As well as this, intensive medical interventions which are futile may cause unnecessary indignity to a person at the end of their life.

EDIT: With respect to your child, I am not commenting on whether medical staff can make incorrect assumptions about people with disability / may not pay enough heed to relatives / may actively discriminate against those with disability when it comes to prolonging life care. What I am saying is that the LCP and palliative care doesn't cause that. In fact at a guess I would say palliative care specialists are actually more likely to be informed about serious disability, are more holistic on average, more likely to listen to relatives. Their goal is absolutely not to finish off patients, just to provide their expertise in end-of-life (including the question "is this the end of life?"). It is no controversy for the palliative care team to get involved because the patient may die despite interventions, but the patient lives because the interventions worked.

(edited 10 years ago)

Reply 5

OMFS_BoneSetter

The LCP has been the subject of poor understanding and media frenzy. I'm a doctor and every case I have seen it used has been to effectively ease pain and suffering, and NOT PROLONG pain and suffering in a dying patient. Families of dying patients often make gross assumptions in their grief and desperation and demand things without really understanding why they are in place. When a person is dying, exactly because of the comments above, their heart starts to fail and their gut starts to fail and they get water in all the wrong places, particularly their lungs. Fluids on your lungs is one of the most distressing things to a patient and to their family and it can become difficult to manage. Another thing, is predicting death is never an exact science, there are patients who are believed to have hours who live for a few extra days and there are dying patients who are believed to have days or weeks, who live for just hours. The LCP is designed to allow for rapid deteriorations and improvements in dying patients health. If a patient gets a bit better without invasive medical treatment then we can stop the LCP and see how they do if they relapse and medical intervention is thought to be futile then we put them back on the LCP.

Fundamentally, there is a gross lack of understanding amongst the non-medical general public. The alternative without the LCP and adequate palliation is sometimes a distressing death for both patient, staff and family involved, but the media conveniently forgets this.

Reply 6

L i b

Original post by medic_armadillo7

Fundamentally, there is a gross lack of understanding amongst the non-medical general public..

The idea that these methods could be deployed without the understanding and consent of the patient's family - or, of course, the patient if capable of understanding - is, however, far more disturbing.

Reply 7

moonkatt

The biggest problem with the Liverpool Care Pathway is not the actual tool itself, it's been the way some people have implemented it. A clear explanation to families and patients for the rationale of each part of the pathway and common sense in the use of it would have meant a lot of the stories in the press wouldn't have existed. I've seen the pathway used in practice to give people good comfortable pain free deaths, this is what it was designed for by the Marie Curie Hospice. Communication is key in it's implementation and this was the pathways biggest enemy. It's something those of us in healthcare should carefully think about because it's something so simple that we manage to get wrong more often than we should.

The pathway may be being removed but I think this will be in name only, something very similar will end up being used in it's place.

Reply 8

OMFS_BoneSetter

Original post by L i b

That's because, to be honest, if a patient is in pain and they are dying we don't have to wait for them to come to a decision about a patient. If a patient is in pain and/or distressed, then they in pain and/or distressed. No amount of discussion with the family will change that and so what they need is palliative treatment. If the opinion of the most senior clinician there authorised to make such decisions, is that they are dying and invasive medical care (like major surgery or intubation and ventilatory support on a frail 95 year old) is either not in their best interests or thought to be absolutely futile, then they can have palliative medication started without the family being present. The talk with the family is just to inform them and to let them know what is happening and potentially be prepared for the passing of their loved one and answer any of their questions.

Reply 9

OMFS_BoneSetter

Original post by moonkatt

I think it's the simplest thing to say that the family were never told or that there was bad communication. I have been in countless situations where a doctor or nurse has spoken to families at length about things and ask if they have any further questions. Only to have that family, speak to another member of staff and say they famous lines, "We don't know what's going on. No-one has told us anything." It has gotten so bad that in the trust where I work, we are encouraged to document a summary of our discussion, (not that we should have to), in case of this type of dispute.

Since employing this change in policy, the only thing that has changed is the fact we have documented evidence. The frequency with which families say "We don't know what's going on. No-one has told us anything", has not changed!