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Dr Stephenson should be congratulated for highlighting the worrying vacuum of care that has developed in many parts of the country [1,2], following the publication of the Independent Review of the Liverpool Care Pathway (LCP) [3]. He states that the "buck stops" with doctors, but many would contend that end-of-life care should be the responsibility of all healthcare professionals (rather than the province of any one group of healthcare professionals).
If anything, the buck should stop with our specialty, i.e. palliative medicine / palliative care. We facilitated the widespread introduction of the LCP (despite the lack of evidence), and patently failed to provide the necessary training / support for many of our non-specialist hospital colleagues. Moreover, we buried our heads in the sand when concerns about the LCP were first raised in the national press in 2009.
The specialty is actively working with others to develop an alternative to the LCP. However, if the alternative is to be credible, then it needs to be evidence-based: such an undertaking cannot be done within the timescales mentioned in the Independent Review, i.e. 6-12 months. Hence, we urgently need to come up with an alternative solution (to prevent even more patients experiencing a “bad” death in hospital).
We have previously described our own “solution” [4], which involves all patients commenced on the LCP being referred to / reviewed by the palliative care team. Our model of care provides support for healthcare professionals, reassurance for patients and carers, and (based on data from a service evaluation) more timely management of pain and other symptoms. Our model of care, or a version thereof, could be immediately rolled out in most hospitals within the United Kingdom.
It is time for palliative medicine / palliative care to accept this “buck”, because no one else is going to do so (and no one else is better qualified to do so)!
References:
1. Stephenson JB. End of life care – the buck stops here. BMJ 2013; 347: f6608.
2. Duffin C. Liverpool Care Pathway: dying to know what will happen next. Nurs Stand 2013; 28: 14-5.
3. Department of Health. More care, less pathway: a review of the Liverpool Care Pathway. 2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
4. Davies AN, Thompson J. The Liverpool Care Pathway for the Dying Patient: throwing the baby out with the bath water? 2013. http://www.bmj.com/content/347/bmj.f4669?tab=responses
Re: End of life care—the buck stops here with doctors
Dr Stephenson should be congratulated for highlighting the worrying vacuum of care that has developed in many parts of the country [1,2], following the publication of the Independent Review of the Liverpool Care Pathway (LCP) [3]. He states that the "buck stops" with doctors, but many would contend that end-of-life care should be the responsibility of all healthcare professionals (rather than the province of any one group of healthcare professionals).
If anything, the buck should stop with our specialty, i.e. palliative medicine / palliative care. We facilitated the widespread introduction of the LCP (despite the lack of evidence), and patently failed to provide the necessary training / support for many of our non-specialist hospital colleagues. Moreover, we buried our heads in the sand when concerns about the LCP were first raised in the national press in 2009.
The specialty is actively working with others to develop an alternative to the LCP. However, if the alternative is to be credible, then it needs to be evidence-based: such an undertaking cannot be done within the timescales mentioned in the Independent Review, i.e. 6-12 months. Hence, we urgently need to come up with an alternative solution (to prevent even more patients experiencing a “bad” death in hospital).
We have previously described our own “solution” [4], which involves all patients commenced on the LCP being referred to / reviewed by the palliative care team. Our model of care provides support for healthcare professionals, reassurance for patients and carers, and (based on data from a service evaluation) more timely management of pain and other symptoms. Our model of care, or a version thereof, could be immediately rolled out in most hospitals within the United Kingdom.
It is time for palliative medicine / palliative care to accept this “buck”, because no one else is going to do so (and no one else is better qualified to do so)!
References:
1. Stephenson JB. End of life care – the buck stops here. BMJ 2013; 347: f6608.
2. Duffin C. Liverpool Care Pathway: dying to know what will happen next. Nurs Stand 2013; 28: 14-5.
3. Department of Health. More care, less pathway: a review of the Liverpool Care Pathway. 2013.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
4. Davies AN, Thompson J. The Liverpool Care Pathway for the Dying Patient: throwing the baby out with the bath water? 2013.
http://www.bmj.com/content/347/bmj.f4669?tab=responses
Competing interests: No competing interests