title: Effectiveness of the Liverpool care pathway for the dying in residential care homes: An exploratory, controlled before-and-after study.
abstract: BACKGROUND
  Clinical pathways aim to ensure that individuals receive appropriate evidence-based care and interventions, with the Liverpool Care Pathway for the Dying Patient focusing on end of life. However, controlled studies of the Liverpool Care Pathway for the Dying Patient, particularly outside of cancer settings, are lacking.
  
  
  OBJECTIVE
  To compare the effects of the Liverpool Care Pathway for the Dying Patient and usual care on patients' symptom distress and well-being during the last days of life, in residential care homes.
  
  
  METHODS
  Exploratory, controlled before-and-after study. During a 15-month baseline, usual care was carried out in two areas. During the following 15-months, usual care continued in the control area, while residential care home staff implemented Liverpool Care Pathway for the Dying Patient use in the intervention area. The intervention was evaluated by family members completing retrospective symptom assessments after the patient's death, using the Edmonton Symptom Assessment System and Views of Informal Carers - Evaluation of Services.
  
  
  METHODS
  Patients who died at all 19 residential care homes in one municipality in Sweden.
  
  
  RESULTS
  Shortness of breath (estimate = -2.46; 95% confidence interval = -4.43 to -0.49) and nausea (estimate = -1.83; 95% confidence interval = -3.12 to -0.54) were significantly reduced in Edmonton Symptom Assessment System in patients in the intervention compared to the control area. A statistically significant improvement in shortness of breath was also found on the Views of Informal Carers - Evaluation of Services item (estimate = -0.47; 95% confidence interval = -0.85 to -0.08).
  
  
  CONCLUSIONS
  When implemented with adequate staff training and support, the Liverpool Care Pathway for the Dying Patient may be a useful tool for providing end-of-life care of elderly people at the end of life in non-cancer settings.
authors.affiliation: Department of Nursing, Umeå University Campus Skellefteå, Umeå, Sweden margareta.brannstrom@nurs.umu.se.
authors.forename: Margareta
authors.initials: M
authors.lastname: Brännström
authors.affiliation: The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Fürst
authors.affiliation: Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.affiliation: Akademistatistik - Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Olav
authors.initials: O
authors.lastname: Lindqvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013548:Sweden; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards
keywords: Clinical pathway; end-of-life care; homes for the aged