title: 'Less ticking the boxes, more providing support': A qualitative study on health professionals' concerns towards the Liverpool Care of the Dying Pathway.
abstract: BACKGROUND
  Despite being widely used, research into the effectiveness of the Liverpool Care of the Dying Pathway (LCP) and associated cases of malpractice does not match dissemination. No study exists focusing on concerns voiced by professionals.
  
  
  OBJECTIVE
  To explore the views of professionals who, during the hospital implementation of the Italian version of the Liverpool Care of the Dying Pathway (LCP-I), voiced or showed concerns towards it.
  
  
  METHODS
  A qualitative study nested within the LCP-I randomized cluster trial, with semi-structured interviews analysed using thematic analysis.
  
  
  METHODS
  Six nurses and five physicians from six out of the eight hospital wards who completed the LCP-I implementation were interviewed. Eligibility criteria were having taken part in all steps of the LCP-I Programme, voiced or somehow shown concerns, or failed to fully engage with the implementation process.
  
  
  RESULTS
  A total of 12 categories were identified, referring to four topics: the Implementation Programme, the LCP-I clinical documentation, the hospital environment and the educational and professional background of hospital healthcare staff. Issues raised by participants concerned both 'real' characteristics of the LCP-I and a misinterpretation of the LCP-I approach and clinical documentation. Furthermore, difficulties were reported which were not linked to the Programme but rather to end-of-life care.
  
  
  CONCLUSIONS
  This study provides insights into the experience of professionals with negative opinions of or concerns with the LCP-I. A more comprehensive approach to professional training in palliative care is needed and may envisage the development of new interventions aimed at improving the quality of care throughout the illness trajectory.
authors.affiliation: Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy Silvia.DiLeo@asmn.re.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Di Leo
authors.affiliation: Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Romoli
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bulli
authors.affiliation: Istituto di Tanatologia e Medicina Psicologica, Bologna, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Fantini
authors.affiliation: Departments of Mental Health and Clinical and Biological Sciences, University of Turin, Turin, Italy Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Sguazzotti
authors.affiliation: Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D019091:Critical Pathways / Q000592:standards*; D004517:Education, Professional / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D011787:Quality of Health Care; D013727:Terminal Care / Q000592:standards*
keywords: End-of-life care; LCP; interviews; qualitative research; thematic analysis; ward professionals