Implementation of the Liverpool Care Pathway (LCP) for the Dying Patient in the Inpatient Hospice Setting: Development and Preliminary Assessment of the Italian LCP Program

Silvia Di Leo, Laura Bono, Vittoria Romoli, Emily West, Raffaella Ambrosio, Michele Gallucci, Paola Pilastri, Pietro La Ciura, Piero Morino, Massimo Piazza, Danila Valenti, Catia Franceschini, Massimo Costantini

Research output: Contribution to journalArticle

Abstract

Background: The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. Aim: Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. Methods: This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. Results: The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. Conclusions: The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.

Original languageEnglish
Pages (from-to)61-68
Number of pages8
JournalAmerican Journal of Hospice and Palliative Medicine
Volume31
Issue number1
DOIs
Publication statusPublished - Feb 2014

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Hospices
Inpatients
Palliative Care
Education
Biomedical Research
Nurses
Physicians

Keywords

  • complex interventions
  • dying
  • End-of-life care
  • hospice
  • implementation process
  • Liverpool Care Pathway

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Implementation of the Liverpool Care Pathway (LCP) for the Dying Patient in the Inpatient Hospice Setting : Development and Preliminary Assessment of the Italian LCP Program. / Leo, Silvia Di; Bono, Laura; Romoli, Vittoria; West, Emily; Ambrosio, Raffaella; Gallucci, Michele; Pilastri, Paola; Ciura, Pietro La; Morino, Piero; Piazza, Massimo; Valenti, Danila; Franceschini, Catia; Costantini, Massimo.

In: American Journal of Hospice and Palliative Medicine, Vol. 31, No. 1, 02.2014, p. 61-68.

Research output: Contribution to journalArticle

Leo, Silvia Di ; Bono, Laura ; Romoli, Vittoria ; West, Emily ; Ambrosio, Raffaella ; Gallucci, Michele ; Pilastri, Paola ; Ciura, Pietro La ; Morino, Piero ; Piazza, Massimo ; Valenti, Danila ; Franceschini, Catia ; Costantini, Massimo. / Implementation of the Liverpool Care Pathway (LCP) for the Dying Patient in the Inpatient Hospice Setting : Development and Preliminary Assessment of the Italian LCP Program. In: American Journal of Hospice and Palliative Medicine. 2014 ; Vol. 31, No. 1. pp. 61-68.
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abstract = "Background: The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. Aim: Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. Methods: This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. Results: The LCP was implemented in all the hospices involved. A high proportion of physicians (50{\%}-100{\%}) and nurses (94{\%}-100{\%}) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6{\%} and 89.1{\%}. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. Conclusions: The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.",
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AU - Bono, Laura

AU - Romoli, Vittoria

AU - West, Emily

AU - Ambrosio, Raffaella

AU - Gallucci, Michele

AU - Pilastri, Paola

AU - Ciura, Pietro La

AU - Morino, Piero

AU - Piazza, Massimo

AU - Valenti, Danila

AU - Franceschini, Catia

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