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.
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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.