Best care for the dying patient

Professor John Ellershaw, Director, Marie Curie Palliative Care Institute Liverpool (MCPCIL), University of Liverpool, UK, explains the background to a longer article published in the May/June issue of the European Journal of Palliative Care.

Professor John Ellershaw

Professor John Ellershaw

There is an urgent need in the UK to find our way to a proper debate about death and dying. As a society it is perhaps our greatest taboo subject, more so than is the case in many other countries with whom we work in partnership to improve care for dying patients. This is having an ongoing detrimental effect on patient care in the here and now and if not addressed will continue to hamper efforts to improve that care for the foreseeable future.

Many readers will be aware of the ongoing public policy and media debate focusing around the Liverpool Care Pathway for the dying patient (LCP).

With strong views – regarding euthanasia on the one hand and preserving life at any cost on the other – the LCP can sometimes become the focus for both sides of a polarised debate. The reality, however, is that the LCP sits squarely in the middle ground of these debates. The LCP seeks neither to hasten death nor prolong life. Indeed, the sole purpose of the LCP is to provide the best possible care for people in the last hours or days of their life.

The LCP programme, of course, is about much more than the document itself, which reflects the ten key elements of best care for the dying patient. The LCP is a continuous quality improvement programme that, when implemented, can support achieving improvements in care for dying patients in that setting.

There are challenges, of course, in achieving best care for dying patients in hospital settings especially when, in England, we have more than half of deaths occurring within hospitals.

We already know from national audits that there is a need for improved education, training and the availability of specialist palliative care teams within hospitals. A key part of this is continuing to focus on ensuring that effective communication – between clinicians, patients and families – is central to care culture and practice.

In March 2011 an international LCP reference group was formed, with representatives from 11 countries involved in LCP Continuous Quality Improvement Programmes. As a group we share many challenges across cultural, and national boundaries and share a common purpose that transcends them – achieving best care for the dying patient.

Read the full article in the May issue of the European Journal of Palliative Care

Read the full article in the May issue of the European Journal of Palliative Care

We have concluded more recently that accreditation of hospitals that care for dying patients could be a useful step forward in ensuring that best care is being implemented, based around the LCP as the model for that best care. This accreditation would strengthen assurance, being based on Continuous Quality Improvement Programme methodology.

We have written as a group in this month’s European Journal of Palliative Care to explain the fuller background and history to the development of the LCP programme and how we have arrived at this view regarding accreditation. We’d welcome colleagues’ views.

To find out more…
The article to which this post relates, ‘Care of the dying and the LCP in England: An international perspective by John Ellershaw, Carl Johan Fürst, Urska Lunder, Mark Boughey, Steffen Eychmüller, Susan Hannam Hodgson, Dagny Faksvåg Haugen, Bridget Marshall, Helen M Walker, Susie Wilkinson, Raymond Voltz and Lia van Zuylen is published in the May/June issue of the European Journal of Palliative Care (vol. 20.3).

If you already have a web-based subscription to the EJPC you will be able to download this issue, plus all articles in the EJPC archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription.

Members of the EAPC receive discounted subscription rates to the EJPC – click here. 



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