title: Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0-1 study according to the Medical Research Council Framework.
abstract: BACKGROUND
  The effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the UK hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards.
  
  
  METHODS
  We conducted a phase 0-1 study according to the Medical Research Council Framework. Phase 0 consisted of a review of existing LCP programmes from the UK, Italy, and the Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, we developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. The care programme was reviewed and refined by two nurses and two physicians working in an acute geriatric ward and by two experts from Italy and the Netherlands.
  
  
  RESULTS
  Phase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation and a summary of the LCP concerns raised in the UK. Based on these findings we developed a new care programme consisting of (1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward, (2) supportive documentation, and (3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.
  
  
  CONCLUSIONS
  Based on the existing LCP programmes and taking into account the key factors for successful LCP implementation as well as the concerns raised in the UK, we developed a care programme for the last days of life and modelled it to the acute geriatric hospital wards after gaining feedback from health professionals caring for older hospitalized patients.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. rebecca.verhofstede@vub.ac.be.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Verhofstede
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. tinne.smets@vub.ac.be.
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. joachim.cohen@vub.ac.be.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. costantini.massimo@asmn.re.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Geriatrics, Ghent University Hospital, Ghent, Belgium. nele.vandennoortgate@uzgent.be.
authors.forename: Nele
authors.initials: N
authors.lastname: Van Den Noortgate
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. a.vanderheide@erasmusmc.nl.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. luc.deliens@vub.ac.be.|Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium. luc.deliens@vub.ac.be.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000368:Aged; D003142:Communication; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards; D005060:Europe; D005190:Family; D005853:Geriatrics; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D010347:Patient Care Planning; D015397:Program Evaluation; D013727:Terminal Care / Q000379:methods* / Q000592:standards*