1. Implementation of the Liverpool Care Pathway (LCP) for the dying patient in the inpatient hospice setting: development and preliminary assessment of the Italian LCP program
- Author
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Vittoria Romoli, Raffaella Ambrosio, Danila Valenti, Pietro La Ciura, Paola Pilastri, Emily West, Silvia Di Leo, Michele Gallucci, Piero Morino, Laura Bono, Catia Franceschini, Massimo Piazza, and Massimo Costantini
- Subjects
medicine.medical_specialty ,Inservice Training ,Attitude of Health Personnel ,Pilot Projects ,Complex interventions ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,030502 gerontology ,Care pathway ,Medicine ,Humans ,030212 general & internal medicine ,Inpatients ,Terminal Care ,business.industry ,Palliative Care ,Hospices ,General Medicine ,3. Good health ,Family medicine ,Critical Pathways ,0305 other medical science ,business ,End-of-life care ,Program Evaluation - Abstract
Background: The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. Aim: Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. Methods: This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. Results: The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. Conclusions: The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.
- Published
- 2013