title: Does the 'Liverpool Care Pathway' facilitate an improvement in quality of care for dying cancer patients?
abstract: BACKGROUND
  The Liverpool Care Pathway for the Dying Patient (LCP) aims to transfer hospice principles of care for dying patients to other health-care sectors. This post-bereavement survey explored the LCP's effectiveness in improving quality of care for cancer patients.
  
  
  METHODS
  Postal self-completion questionnaires were sent to 778 next-of-kin to consecutive deceased patients who had died an 'expected' cancer death in a hospice and acute tertiary hospital.
  
  
  RESULTS
  Following exclusions (n=53), 255 of the 725 next-of-kin agreed to participate (35.2% response rate). Overall hospice participants reported the best quality of care, and hospital participants, for whom care was not supported by the LCP, reported the worst quality of care. Multivariate analysis showed the hospice was an independent predictor for patients being treated with dignity (OR 8.46) and receiving adequate family support (OR 7.18) (P<0.0001). Care supported by the LCP and the hospital specialist palliative care team were both associated with good family support, but neither was an independent predictor.
  
  
  CONCLUSIONS
  From the bereaved relatives' perspective, within the hospital, the LCP is effective in improving specific aspects of care, such as symptom control for dying patients. Further improvement is required, however, to attain the hospice standard of care.
authors.affiliation: Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, L3 9TA, UK. catriona.mayland@liv.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Mayland
authors.forename: E M I
authors.initials: EM
authors.lastname: Williams
authors.forename: J
authors.initials: J
authors.lastname: Addington-Hall
authors.forename: T F
authors.initials: TF
authors.lastname: Cox
authors.forename: J E
authors.initials: JE
authors.lastname: Ellershaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D019452:Terminally Ill; D006113:United Kingdom