title: Improvements in end-of-life care with a protocol-based pathway for cancer patients dying in a Singapore hospital.
abstract: BACKGROUND
  More than half of all deaths in Singapore occur in hospitals. Little is known about the quality of care received by dying patients in hospitals. The Liverpool Care Pathway (LCP) provides a framework of providing good end-of-life care for dying patients and has been used with success in the United Kingdom (UK). In this study, we investigate whether adoption of a modified LCP in a Singapore hospital translated to better end-of-life care for cancer patients.
  
  
  METHODS
  The LCP was adapted and implemented as a pilot project on an oncology ward in Singapore General Hospital. A baseline review of 30 consecutive death records was performed, followed by a 4-month pilot and post-implementation audit of 30 consecutive patients on the adapted LCP.
  
  
  RESULTS
  Five types of end-of-life symptoms were analysed. There was only 1 uncontrolled symptom at death in the post-implementation group compared to 24 uncontrolled symptoms in the retrospective audit group. The prescription of breakthrough medications for symptom control increased from 21% in the retrospective audit group to 79% in the post-implementation group. Inappropriate monitoring was discontinued in 25 patients in the post-implementation group compared to none in the retrospective audit group. The documentation of resuscitation status and religion of the patient was improved, achieving full documentation in the post-implementation group.
  
  
  CONCLUSIONS
  This study shows promising results for improving end-of-life care in cancer patients with a protocol-based pathway in a Singapore hospital. Extension of this care pathway to other settings should be explored to maximise its benefits to patients dying from all causes in hospital.
authors.affiliation: Department of Palliative Medicine, National Cancer Centre Singapore, Singapore. Neo.S.H@nccs.com.sg
authors.forename: Patricia S H
authors.initials: PS
authors.lastname: Neo
authors.forename: Mai Chan
authors.initials: MC
authors.lastname: Poon
authors.forename: Tan Ying
authors.initials: TY
authors.lastname: Peh
authors.forename: Simon Y K
authors.initials: SY
authors.lastname: Ong
authors.forename: Wen Hsin
authors.initials: WH
authors.lastname: Koo
authors.forename: Ulina
authors.initials: U
authors.lastname: Santoso
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Goh
authors.forename: Alethea C P
authors.initials: AC
authors.lastname: Yee
mesh_terms: D019091:Critical Pathways / Q000592:standards*; D004059:Diffusion of Innovation; D005260:Female; D017052:Hospital Mortality; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms; D058996:Quality Improvement; D012189:Retrospective Studies; D012846:Singapore; D013727:Terminal Care / Q000592:standards*; D062606:Tertiary Care Centers; D006113:United Kingdom