title: Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life care.
abstract: OBJECTIVE
  To explore the experiences, challenges and practices of critical care practitioners since the discontinuation of the Liverpool Care Pathway in critical care settings.
  
  
  BACKGROUND
  The Liverpool Care Pathway was widely used with an aim to improve communication and care for dying individuals and their relatives. However, widespread media criticism prompted a review, which resulted in the discontinuation of the Liverpool Care Pathway across all UK clinical settings.
  
  
  METHODS
  A qualitative study.
  
  
  METHODS
  The study was carried out in two large acute hospitals in England. Semi-structured interviews were conducted with 14 critical care practitioners, 6 months after discontinuation of the Liverpool Care Pathway. Transcribed verbatim data were analysed using framework analysis.
  
  
  RESULTS
  Three key themes emerged: 'lessons learned', 'uncertainties and ambivalences' and 'the future'. Critical care practitioners reported that life after the Liverpool Care Pathway in critical care settings often involved various clinical ambivalences, uncertainties and inconsistencies in the delivery of end-of-life care, especially for less experienced practitioners. Critical care practitioners had 'become accustomed' to the components of the Liverpool Care Pathway, which still guide them in principle to ensure quality end-of-life care. The Liverpool Care Pathway's structured format was perceived to be a useful clinical tool, but was also criticized as a 'tick-box exercise' and for lacking in family involvement.
  
  
  CONCLUSIONS
  This study posits two key conclusions. Despite experienced critical care practitioners being able to deliver quality end-of-life care without using the Liverpool Care Pathway, junior nursing and medical staff need clear guidelines and support from experienced mentors in practice. Evidence-based guidelines related to family involvement in end-of-life care planning in critical care settings are also needed to avoid future controversies.
authors.affiliation: Department of Healthcare Practice, Faculty of Health and Social Sciences, University of Bedfordshire, Aylesbury, Buckinghamshire, UK.
authors.forename: Munikumar
authors.initials: M
authors.lastname: Ramasamy Venkatasalu
authors.affiliation: Department of Healthcare Practice, Faculty of Health and Social Sciences, University of Bedfordshire, Aylesbury, Buckinghamshire, UK.
authors.forename: Dean
authors.initials: D
authors.lastname: Whiting
authors.affiliation: Department of Healthcare Practice, Faculty of Health and Social Sciences, University of Bedfordshire, Buckinghamshire Campus, Oxford House, Oxford Road, Aylesbury, Buckinghamshire, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Cairnduff
mesh_terms: D000328:Adult; D003422:Critical Care; D019091:Critical Pathways; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008503:Medical Staff; D008875:Middle Aged; D036301:Qualitative Research; D013727:Terminal Care
keywords: LCP; care pathways; critical care; death and dying; end-of-life care; experiences; liverpool care pathway; nurses; qualitative approaches