End of Life Care: How appropriate is a pathway?
14th May 2014
BBC Radio 4: Inside Health. Caring for the Dying
The Inside Health, BBC Radio 4 programme discuss the highly debated issue around how to best care for the dying. Please use the link above to listen to the programme.
Caring for the dying is an important consideration for hospitals. Over 30% of people in hospital at any given time are nearing the end of their life and half of the population actually die in hospital. With this in mind the Liverpool Care Pathway was introduced to help nurses provide better care for the dying. This pathway was initially well received and appeared effective with well resourced, well trained and sensitive clinical teams. However, other families felt this pathway resulted in a lack of basic care, over-prescription of strong pain killers and limited communication between the medical staff and the patient and their family. These concerns were exacerbated by the fact the Liverpool Care Pathway was incentivised which created a view that it was a tick box exercise rather than a process which is grounded in clinical, ethical and caring decision making.
In an attempt to address how the dying are cared for in hospital, the emphasis has changed from using a pathway to promoting personal choice. This involves having a personalised end of life care plan which aligns with what people would like to happen. The two main areas of change are the introduction of an allocated clinician to each patient and a focus on hydration and nutrition. Additional areas that are considered involve the training of staff, gaining feedback from bereaved families and a consideration of how this approach can be regulated to ensure an effective way of caring rather than a tick box exercise.
Dying in a hospital environment can cause the patient’s situation to become ‘over medicalised’ where the person’s wishes are often unknown. This new approach aims to be more relationship based, focusing on advanced care planning, regularly reviewed discussions and a care plan which is developed on an individual by individual basis.