Do End-of-Life Care Pathways Improve Outcomes in Caring for the Dying?

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Excerpt

Internationally, it is reported that most deaths occur in institutional settings, mainly hospitals and nursing homes.1 In these facilities, nurses are the professionals who predominantly coordinate and provide care for people in the terminal phase. In the past, dying patients in hospitals received inadequate end-of-life care, specifically symptom control and basic nursing cares.2 It was identified that improvements must be made and a holistic approach to end of life care was required to ensure dying people's comfort and dignity.2
Integrated care pathways are used in many healthcare settings to guide and standardize care for patients with a specific clinical problem.3 The Liverpool Care Pathway (LCP) is an integrated care pathway, specifically for the provision of terminal care.4,5 The pathway focuses on the physical, psychosocial, spiritual, and religious elements of end-of-life care as provided in the hospice setting.6 Nineteen essential goals are outlined in regard to caring for the dying patients and their family or carer after death.4,5 Other pathways also exist to guide care of dying people based on these principles7–9; however, the LCP is arguably the most widely used.
Internationally, end-of-life care pathways are widely used; however, the use of such pathways is controversial.10 There have been serious concerns raised regarding the safety of implementing end-of-life care pathways, particularly in the United Kingdom.11 It is essential that nurses working with dying people are aware of the evidence surrounding the use of end-of-life care pathways to inform their own practice.
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