Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: a realist evaluation.
OBJECTIVE
The Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation.


METHODS
An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semistructured interviews were conducted with two policymakers and 22 participants with experience and/or involvement in management of the LCP during 2011 and 2012.


RESULTS
Key resource inputs included facilitation with a view to maintaining LCP 'visibility', reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy, and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care.


CONCLUSIONS
There is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.
School of Nursing and Midwifery, Queen's University, Belfast, UK.
Tracey
T
McConnell
School of Nursing and Midwifery, Queen's University, Belfast, UK.
Peter
P
O'Halloran
School of Medicine, Dentistry and Biomedical Sciences, Centre of Excellence for Public Health, Belfast, UK.
Michael
M
Donnelly
School of Nursing and Midwifery, Queen's University, Belfast, UK.
Sam
S
Porter
D019091:Critical Pathways / Q000592:standards*; D004059:Diffusion of Innovation; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006300:Health Services Misuse; D017051:Hospice Care; D006739:Hospital Administration; D006801:Humans; D007407:Interviews as Topic; D008503:Medical Staff / Q000193:education; D009660:Northern Ireland; D009740:Nursing Staff / Q000193:education; D019982:Organizational Case Studies; D015397:Program Evaluation; D058996:Quality Improvement; D020377:Self Efficacy; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D019452:Terminally Ill