title: Implementation of the Liverpool Care Pathway (LCP) for the dying patient in the inpatient hospice setting: development and preliminary assessment of the Italian LCP program.
abstract: BACKGROUND
  The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce.
  
  
  OBJECTIVE
  Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting.
  
  
  METHODS
  This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices.
  
  
  RESULTS
  The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases.
  
  
  CONCLUSIONS
  The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.
authors.affiliation: 1Regional Palliative Care Network, IRCSS AOU S. Martino-IST, Genoa, Italy.
authors.forename: Silvia Di
authors.initials: SD
authors.lastname: Leo
authors.forename: Laura
authors.initials: L
authors.lastname: Bono
authors.forename: Vittoria
authors.initials: V
authors.lastname: Romoli
authors.forename: Emily
authors.initials: E
authors.lastname: West
authors.forename: Raffaella
authors.initials: R
authors.lastname: Ambrosio
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
authors.forename: Paola
authors.initials: P
authors.lastname: Pilastri
authors.forename: Pietro La
authors.initials: PL
authors.lastname: Ciura
authors.forename: Piero
authors.initials: P
authors.lastname: Morino
authors.forename: Massimo
authors.initials: M
authors.lastname: Piazza
authors.forename: Danila
authors.initials: D
authors.lastname: Valenti
authors.forename: Catia
authors.initials: C
authors.lastname: Franceschini
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
mesh_terms: D001291:Attitude of Health Personnel; D019091:Critical Pathways / Q000458:organization & administration*; D006738:Hospices / Q000458:organization & administration*; D006801:Humans; D007297:Inpatients; D007318:Inservice Training / Q000458:organization & administration; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D015397:Program Evaluation; D013727:Terminal Care / Q000379:methods*
keywords: End-of-life care; Liverpool Care Pathway; complex interventions; dying; hospice; implementation process