The Liverpool Care Pathway for cancer patients dying in hospital medical wards: A before-after cluster phase II trial of outcomes reported by family members

Massimo Costantini, Fabio Pellegrini, Silvia Di Leo, Monica Beccaro, Carla Rossi, Guia Flego, Vittoria Romoli, Michela Giannotti, Paola Morone, Giovanni P. Ivaldi, Laura Cavallo, Flavio Fusco, Irene J. Higginson

Research output: Contribution to journalArticle

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Abstract

Background: Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Aim: Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Design: Uncontrolled before-after intervention cluster trial. Settings/participants: The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2-4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient's death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0-100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). Results: An interview was obtained for 79 family members, 46 (73.0%) before and 33 (68.8%) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95% confidence interval = 3.6-30.0; p = 0.015); family emotional support (+20.9; 95% confidence interval = 9.6-32.3; p <0.001); family self-efficacy (+14.3; 95% confidence interval = 0.3-28.2; p = 0.049) and coordination of care (+14.3; 95% confidence interval = 4.2-24.3; p = 0.007). No significant improvement in symptom' control was observed. Conclusions: These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control suggests areas for further innovation and development.

Original languageEnglish
Pages (from-to)10-17
Number of pages8
JournalPalliative Medicine
Volume28
Issue number1
DOIs
Publication statusPublished - 2014

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Terminal Care
Confidence Intervals
Neoplasms
Quality of Life
Interviews
Quality of Health Care
Self Efficacy
Dyspnea
Nausea
Caregivers
Vomiting
Pain

Keywords

  • Cancer
  • end-of-life care
  • hospital
  • Liverpool Care Pathway
  • palliative care
  • quality of health care

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine

Cite this

The Liverpool Care Pathway for cancer patients dying in hospital medical wards : A before-after cluster phase II trial of outcomes reported by family members. / Costantini, Massimo; Pellegrini, Fabio; Di Leo, Silvia; Beccaro, Monica; Rossi, Carla; Flego, Guia; Romoli, Vittoria; Giannotti, Michela; Morone, Paola; Ivaldi, Giovanni P.; Cavallo, Laura; Fusco, Flavio; Higginson, Irene J.

In: Palliative Medicine, Vol. 28, No. 1, 2014, p. 10-17.

Research output: Contribution to journalArticle

Costantini, M, Pellegrini, F, Di Leo, S, Beccaro, M, Rossi, C, Flego, G, Romoli, V, Giannotti, M, Morone, P, Ivaldi, GP, Cavallo, L, Fusco, F & Higginson, IJ 2014, 'The Liverpool Care Pathway for cancer patients dying in hospital medical wards: A before-after cluster phase II trial of outcomes reported by family members', Palliative Medicine, vol. 28, no. 1, pp. 10-17. https://doi.org/10.1177/0269216313487569
Costantini, Massimo ; Pellegrini, Fabio ; Di Leo, Silvia ; Beccaro, Monica ; Rossi, Carla ; Flego, Guia ; Romoli, Vittoria ; Giannotti, Michela ; Morone, Paola ; Ivaldi, Giovanni P. ; Cavallo, Laura ; Fusco, Flavio ; Higginson, Irene J. / The Liverpool Care Pathway for cancer patients dying in hospital medical wards : A before-after cluster phase II trial of outcomes reported by family members. In: Palliative Medicine. 2014 ; Vol. 28, No. 1. pp. 10-17.
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abstract = "Background: Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Aim: Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Design: Uncontrolled before-after intervention cluster trial. Settings/participants: The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2-4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient's death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0-100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). Results: An interview was obtained for 79 family members, 46 (73.0{\%}) before and 33 (68.8{\%}) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95{\%} confidence interval = 3.6-30.0; p = 0.015); family emotional support (+20.9; 95{\%} confidence interval = 9.6-32.3; p <0.001); family self-efficacy (+14.3; 95{\%} confidence interval = 0.3-28.2; p = 0.049) and coordination of care (+14.3; 95{\%} confidence interval = 4.2-24.3; p = 0.007). No significant improvement in symptom' control was observed. Conclusions: These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control suggests areas for further innovation and development.",
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