End-of-life care pathways for improving outcomes in caring for the dying.
BACKGROUND
In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems. Particularly, care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. They aim to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. Therefore, there is a significant need for clinicians to be informed about the utilisation of end-of-life care pathways with a systematic review.


OBJECTIVE
To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community).


METHODS
The Cochrane Register of controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register, MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The search was carried out in September 2009.


METHODS
All randomised controlled trials (RCTs), quasi-randomised trial or high quality controlled before and after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying.


METHODS
Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors.


RESULTS
The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review.


CONCLUSIONS
Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. RCTs or other well designed controlled studies are needed for evaluating the use of end-of-life care pathways in caring for dying people.
Chan
Raymond
R
Cancer Care Services, Royal Brisbane and Women's Hospital, Level 2, Building 34,, Butterfield Street, Herston, Australia, QLD 4029.
Webster
Joan
J
D019091:Critical Pathways; D006801:Humans; D013727:Terminal Care; D016896:Treatment Outcome