Big Issue: Why the Liverpool Care Pathway can help if used in the right way, by Sian Cole at Cotswold Care Hospice
TELLING a person that they may be near the end of life or breaking the news to their loved ones is never easy.
A national audit of the Liverpool Care Pathway, suggests there are 57,000 patients a year dying in NHS hospitals without being told that treatment has switched from curative to supportive and palliative care.
Many of those negative experiences of the pathway are because decisions regarding care and treatment are not clearly communicated.
Many staff feel ill-equipped to deliver bad news. They are concerned if they start these conversations they will be faced with questions to which they may not have the time, skills or expertise to answer.
NEW PROMOTIONS put out each calender month! Dont miss out!
Terms: Terms and conditions are when order is complete in full 5% discount will be given with this voucher!
Contact: 01452 223149
Valid until: Sunday, June 30 2013
Just as a clinical skill can be learnt, so can the skills of good communication.
The Liverpool Care Pathway evolved from the models of good care provided by hospices. It is a tool for NHS hospitals and care providers to help deliver care for those who are reaching the end of life.
It is designed to be attentive to the needs of and relieve suffering in dying patients, to help provide a "good death".
It should prompt health care professionals to have open discussions with relatives and, if possible, the patients, to allow them to talk about how they wish to be cared for and where they would like to die.
It is about stopping unnecessary medication, to discontinue futile medical interventions and to shift our focus of care to symptom control, comfort and dignity.
The real issue is that those discussions with the patient and/or their relations appear not to be happening.
Is it any wonder that the families are distraught?
One minute they see their loved one having X-rays, blood tests and treatment and then the next moment it appears to have all stopped. Without being told what is going on, about how close their loved one may be near the end, why wouldn't it be perceived as that the doctors simply trying to hasten their loved one's death?
As a hospice we have a duty to deliver good quality end of life care; equally we see an important role for Cotswold Care Hospice to train health professionals who use the pathway.
We teach them how to communicate in such a sensitive time, to encourage people to talk and to learn to listen to what they are saying, and more importantly what they are not saying.
Hospices take the holistic approach to care. We treat not only the patient but the whole family. In a hospice setting, these difficult discussions start early, often using Advanced Care Plans. It is a record of their wishes and can include decisions regarding everything from resuscitation in an emergency, to where they wish to be cared for, to the songs they wish to have played at their funeral.
Good palliative care – when medical treatments cannot cure – is founded on good communication. No matter what the care setting, everyone involved in patient care needs to ensure that they communicate in a timely and effective way. This includes checking the message has been understood and that patient and family know who to talk to if they have any questions.
It is not a case of "there is nothing more we can do" but a case of focussing on care and comfort – physically, emotionally and spiritually.
The pathway approach is intended to ensure that people can die with dignity and comfort instead of enduring invasive and painful treatments that offer no benefit.
It can achieve that but only if the family are involved in these discussions and feel they are part of the process. These are not easy discussions and the NHS has recognised that. But we have a long way to go.
One thing is certain: we are all going to die. We need to talk openly about it and properly plan for it. By emotionally supporting the relatives and keeping them well informed, it will make the grieving process that little bit easier.
3 Comments
by EyesWideOpen
Monday, January 28 2013, 3:37PM
“The Pathway is flawed and dangerous. The Pathway is giving clinicians a tremendous power which is often wielded precariously. I unreservedly make this statement, not as an "uninformed" and "stupid" person (these are some remarks made on a "Pro-LCP" webpage) but as someone who values the life of all beings, and as a Grandaughter to the most beautiful, strong and amazing woman ever to have walked this Earth. To have experienced first-hand people playing God, deciding she had reached the end of her days and terminating her life with no discussion surrounding this with Nan (who was fully compos mentis before they terminally sedated her) or the family, but instead deceiving us in order to have Nan admitted to a hospital (for physio, which she never received, as they pumped her with morphine instead) where they could carry out their evil plan, is but one example of the depraved and corrupt practice that is operating right now within the medical industry.”
by willyoung
Monday, January 28 2013, 3:10PM
“The Liverpool Care Pathway has only been highly criticised since NHS hospital wards have adopted its use. Therefore, confine the "pathway" back to the hospice environment.
I write with both good and bad experience. My late mother contracted, and fought Leukemia for 2 1/2 years. When she couldn't endure further chemotherapy, she called the family together and entered hospital for palliative care.
On the other hand, my late beloved was placed on the "pathway" without anyones knowledge following a day surgery procedure. In the absence of any history of cancer she passed away within 3 weeks of her lung cancer diagnosis? Legal proceedings have commenced since investigations have revealed the lung nodules were, in fact, multiple pulmonary emboli.
In this instance, had the pathway been confined to hospice settings, the most catastrophic error by a radiologist would not have triggered the pathway on a misdiagnosis?”
by ogrizek
Monday, January 28 2013, 12:52PM
“I've written about the same "protocol" in Canada. It's a bit frightening because I signed a DNR, at the urging of doctors, for my mother over 4 years ago and she is still alive. It is very hard to predict death, harder than I think most people realize. I wrote about my family's experience. http://tinyurl.com/ampn3ea”