Experiences with the Liverpool care pathway for the dying patient in nursing home residents: a mixed-method study to ass
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RESEARCH ARTICLE
Open Access
Experiences with the Liverpool care pathway for the dying patient in nursing home residents: a mixed-method study to assess physicians’ and nurse practitioners’ perceptions Maartje S. Klapwijk1,2* , Natashe Lemos Dekker3, Monique A. A. Caljouw1, Wilco P. Achterberg1 and Jenny T. van der Steen1
Abstract Background: The Liverpool care pathway for the dying patient (LCP) is a multidisciplinary tool developed for the dying phase for use in palliative care settings. The literature reports divergent experiences with its application in a nursing home setting related to its implementation and staff competencies. The aim of this study is to understand how the LCP is being used in the context of the nursing home, including for residents with dementia, and experienced from the perspectives of those responsible for medical treatment in nursing homes. Methods: A mixed-methods approach was used, consisting of a survey followed by interviews. A link to a 9-item online survey with closed and open-ended questions was emailed to all physicians and nurse practitioners of 33 care organisations with nursing homes in three regions of the Netherlands (North, West and South). In addition, 10 respondents with particularly positive or negative experiences were selected for semi-structured interviews. Results: The survey was completed by 159 physicians and nurse practitioners. The respondents were very positive on the content and less positive on the use of the LCP, although they reported difficulties identifying the right time to start the LCP, especially in case of dementia. Also using the LCP was more complicated after the implementation of the electronic health record. The LCP was judged to be a marker of quality for the assessment of symptoms in the dying phase and communication with relatives. Conclusion: An instrument that prompts regular assessment of a dying person was perceived by those responsible for (medical) care to contribute to good care. As such, the LCP was valued, but there was a clear need to start it earlier than in the last days or hours of life, a need for a shorter version, and for integration of the LCP in the electronic health record. Regular assessments with an instrument that focusses on quality of care and good symptom control can improve palliative care for nursing home residents with and without dementia. Keywords: End-of-life care, Liverpool care pathway, Quality of care, Palliative care, Dementia, Nursing home
* Correspondence: [email protected] 1 Department of Public Health and Primary Care, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, the Netherlands 2 Marente, Leiden, the Netherlands Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, prov
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