The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

Massimo Costantini, Simona Ottonelli, Laura Canavacci, Fabio Pellegrini, Monica Beccaro, Silvia Di Leo, Gabriella Morasso, Guido Miccinesi, Cinzia Brunelli, Cinzia Martini, Carlo Peruselli, Sergio Grubich, Claudia Borreani, Danila Valenti, Catia Franceschini, Irene J. Higginson, John Ellershaw, Stein Kaasa

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Abstract

Background. Most cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now. Methods and design. This is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit. The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview". Discussion. This study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm. Research ID. RFPS-2006-6-341619. Trial registration. ClinicalTrials.gov Identifier: NCT01081899.

Original languageEnglish
Article number13
JournalBMC Health Services Research
Volume11
DOIs
Publication statusPublished - 2011

ASJC Scopus subject areas

  • Health Policy

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    Costantini, M., Ottonelli, S., Canavacci, L., Pellegrini, F., Beccaro, M., Di Leo, S., Morasso, G., Miccinesi, G., Brunelli, C., Martini, C., Peruselli, C., Grubich, S., Borreani, C., Valenti, D., Franceschini, C., Higginson, I. J., Ellershaw, J., & Kaasa, S. (2011). The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial. BMC Health Services Research, 11, [13]. https://doi.org/10.1186/1472-6963-11-13