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The End of Life Care Pathway

What is the End of Life Care Pathway?

The End of Life Care Pathway is a holistic, ‘whole-person’ approach to end of life care and dying, recommended to be used wherever someone wishes to die, whether it be a hospital, care home or in their own home. The pathway includes a commitment to honest discussions with the person at the start of their journey so that their wishes for care are respected at all stages. This is sometimes also referred to as ‘dying well’. There are six stages to the pathway which should be followed by clinicians and caregivers, which include recognising spiritual care for the person, support for their family and the carers themselves, as well as keeping them informed at every stage.

The NHS and other experts from the Leadership Alliance for the Care of Dying People identified 5 priorities for care that customers and carers can expect to receive in the last few days and hours of life. This was brought into practice in 2014 to succeed the Liverpool Care Pathway (LCP).

  1. You should be seen by a doctor regularly and if they believe you will die very soon, they must explain this to you and the people close to you.
  2. The staff involved in your care should talk sensitively and honestly to you and the people close to you.
  3. You and the people close to you should be involved in decisions about how you are treated and cared for, if this is what you want.
  4. The needs of your family and other people close to you should be met as far as possible.
  5. An individual plan of care should be agreed with you and delivered with compassion.

Who is the End of Life Care Pathway for?

The End of Life Care Pathway is for anyone who is identified as most likely coming to the end of their life in the next few days or hours. It will help a person to live as well as possible, until they die, and it includes a focus on dying with dignity. Alzheimer’s UK recognises that when someone gets within days or hours of dying they will often:

  • deteriorate more quickly than before
  • lose consciousness
  • be unable to swallow
  • become agitated or restless
  • develop an irregular breathing pattern
  • have cold hands and feet.

What was the Liverpool Care Pathway?

The Liverpool Care Pathway for the Dying Patient (LCP) was a care pathway implemented in the United Kingdom (except Wales) during the late 1990s that was meant to demonstrate a more patient-centred process for end-of-life care. It was devised by the Royal Liverpool University Hospital in collaboration with the Marie Curie Palliative Care Institute to improve care for terminally ill cancer patients, although it was subsequently extended to all patients who were identified as being at the end of their life.

Initially, it was welcomed as a positive move, however by 2009 it was being heavily criticised in the media due to what was reported as it’s inflexibility and lack of person-centred care, as well as the lack of consideration when patients may have had potential to improve. Opinions were also sometimes divided amongst medical staff on how the LCP should be implemented.

The LCP was broken down into stages, the first of which was meant to see a multidisciplinary care team agreeing that the patient was ‘dying’ and therefore deciding on a plan for continuing medical treatment, discontinuation of treatment and comfort measures of the patient. Criticism came from many angles stating that the guidelines weren’t being adhered to or weren’t clear in their guidance, with many clinical decisions being taken without suitably qualified staff being present.

There was also criticism from family members that they weren’t told their relatives had been placed on the LCP or that they were in fact classified as ‘dying’. It was replaced in 2014 by the National End of Life Care Program (NEoLCP).


Further information and advice

If you are unsure who to talk to about your or your loved one’s wishes around end-of-life, palliative care, or care in general, Helping Hands have over 30 years of home care experience, and we have cared for thousands of customers to remain in the home they love, being fully cared for, until the end of their life. If you would like to learn more, please contact us or request a call back; our helpful customer care specialists are waiting to speak to you seven days a week for your convenience.

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