Letters Liverpool care pathway

Change the culture around death and dying in acute hospitals

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1828 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1828
  1. J Gibbins, consultant in palliative medicine1,
  2. K Forbes, consultant in palliative medicine2,
  3. R McCoubrie, consultant in palliative medicine2,
  4. C Reid, consultant in palliative medicine2
  1. 1Cornwall Hospice Care, St Julia’s Hospice, Hayle TR27 4JA, UK
  2. 2University Hospitals Bristol NHS Trust, Bristol BS2 8ED, UK
  1. janegibbins{at}hotmail.com

Chinthapalli’s report broadens the debate on the Liverpool care pathway (LCP).1 Recent negative press coverage has affected end of life care: at University Hospitals Bristol NHS Trust our end of life tool (not LCP) was used in only 37% of patients dying in December 2012 compared with 67% in December 2011.

The principles of the LCP are essential to improving care of the dying, but for this to happen healthcare professionals in acute hospitals must be willing, or allowed, to consider that a patient is dying. Chinthapalli reported that 92% of non-palliative medicine doctors (with experience in palliative medicine) and 78% of palliative medicine consultants thought that doctors and nurses could judge when a patient was dying. It would be interesting to know what hospital clinicians without such experience think, because the diagnosis of dying is made very close to death in most patients,2 with the average time spent on the LCP being 29 hours.3

Findings from our mixed methods study on the impact of a simple end of life tool on care given to the dying in an acute hospital provides helpful insights.4 5 During interviews, doctors and nurses described a culture that required “bravery” to acknowledge a patient might be dying (unpublished data). If our findings resonate with other hospitals, this might explain why a good idea based on best practice has not always translated into good care. The proposed training in communication and the recognition of the dying patient should help,1 but only if attitudes change too.

If acute hospitals continue to ignore this culture, care of the dying is unlikely to change. We must be brave enough to tackle this problem so that care is improved for all dying patients.


Cite this as: BMJ 2013;346:f1828