Nine out of 10 palliative care experts would choose Liverpool care pathway for themselves

The Liverpool care pathway represents best practice for the care of dying patients, according to 89% of UK palliative medicine consultants in an online survey by the BMJ and Channel 4’s Dispatches programme.1

The same proportion of consultants said they would choose it for themselves if they were dying from a terminal illness, and over 97% of consultants thought that the pathway allows patients to die with dignity when used correctly.

The anonymous online survey was emailed to 3021 hospital doctors in early February. The results are based on responses from 563 doctors who had used the pathway in their practice. These respondents comprised 185 palliative medicine consultants (about 40% of the total UK consultant workforce in the specialty), 210 doctors in other specialties, and 168 in other grades in palliative medicine.

Almost three quarters (74%) of the palliative medicine consultants also thought that recent negative press coverage had led to less use of the Liverpool care pathway. Of these consultants, 60% said patients and relatives had asked them not to use it and 80% said staff were apprehensive about relatives’ complaints.

One specialist said the negative coverage “has caused additional distress for relatives at an already distressing time when their loved one is dying.” Another said that this “scaremongering” was “putting end of life care back about 20 years.”

The Liverpool care pathway is the most widely used integrated care pathway for end of life care, but it has recently been criticised after accounts in the media of patients having food and fluids withdrawn and hospitals being offered financial incentives for using the pathway.2 As a result, the Department of Health and the NHS national end of life care programme are currently reviewing the pathway.3

Despite the media reports, almost all doctors (98%) did not think that pressure on beds or other resources had influenced decisions to use the pathway. However, only 13% of all doctors agreed that hospitals should be offered financial incentives for using the pathway, with over half (58%) disagreeing.

The survey also raised concerns over training and lack of understanding. Seventy eight per cent of palliative medicine consultants thought that doctors and nurses were able to judge when a patient was dying, but doctors in other specialties thought that only 69% of relevant healthcare professionals were trained in the use of the Liverpool care pathway at their workplace.

Many commented on damaging misconceptions of the pathway that were perpetuated by the media, and one pointed out that “there is no barrier to eating, drinking, [taking] antibiotics and fluids while on the pathway, if deemed appropriate for symptom management.” Furthermore, another said that “regular review does happen” and the pathway should not be seen as a one way process.

Dr Fiona Godlee, BMJ editor in chief, said: “This survey gives overwhelming support for the Liverpool care pathway from doctors who have experience in using the pathway when caring for patients in the last few days of life.

“The fact that most of these doctors said they would choose the pathway for themselves is doubly reassuring. The recent adverse media coverage of the Liverpool care pathway has been misleading and has damaged patient care. I hope this survey goes some way to restoring public confidence in the pathway as a reasonable and compassionate choice for patients and their families when making decisions about end of life care.”

The results are also due to be aired on Channel 4’s Dispatches on Monday 4 March 2013.