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Why is the Liverpool care pathway used for some dying cancer patients and not others? Healthcare professionals’ perspectives

Freemantle, Alison; Seymour, Jane


Alison Freemantle

Jane Seymour


Despite evidence suggesting that the Liverpool Care Pathway for the Dying Patient is a structured and proficient means of supporting care delivery in the last hours or days of life, discrepancies in uptake are widespread. This exploratory study sought to understand why patients dying of cancer in oncology wards of one hospital trust were, or were not, supported by the LCP. A purposive qualitative case study design was used; each case represented a patient who had died and their most involved nurse and doctor. In-depth interviews explored both recollections of the ‘case’ and wider experiences of using the Pathway in end-of-life care. Eleven healthcare professionals were interviewed about their involvement in the end-of-life care of six patients. For four of these patients care was supported by the LCP.

Although doctors and nurses reported they preferred to use the Pathway to ensure comfortable death, an important factor influencing their decisions was time of death. Access to timely senior review was regarded as an essential preliminary to placing patients on the Pathway but delayed access ‘out of hours’ was commonly experienced and tensions arose from balancing conflicting priorities. Consequently, the needs of dying patients sometimes failed to compete with those receiving curative treatment.

This study suggests that greater attention should be focused on ‘out of hours’ care in hospitals to ensure regular senior review of all patients at risk of dying and to support front line staff to communicate effectively and make contingency plans focused on patients’ best interests.


Freemantle, A., & Seymour, J. (2012). Why is the Liverpool care pathway used for some dying cancer patients and not others? Healthcare professionals’ perspectives. BMC Research Notes, 5(524), doi:10.1186/1756-0500-5-524

Journal Article Type Article
Publication Date Sep 24, 2012
Deposit Date Apr 1, 2014
Publicly Available Date Apr 1, 2014
Journal BMC Research Notes
Electronic ISSN 1756-0500
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 5
Issue 524
Public URL
Publisher URL
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