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It was entirely predictable that the LACDP's 'replacement' for the Liverpool Care Pathway, has confused some healthcare professionals. One reason the LCP was heavily criticised, is that it was [apparently] seen by some HCPs 'as a process into which patients are fitted', whereas good end-of-life care involves fitting the treatment provided to the clinical needs and wider-life requirements of individual patients.
Two patients in identical clinical situations, might have very different objectives and therefore make different choices about which treatments to accept - people are not all alike, 'we are not tins of baked beans'.
So the LACDP effectively said that end-of-life care has to be based on offering the best treatments which can be provided, combined with individual patients making their own choices about which offered treatments to accept: add in that 'I have not died before, so I can't really predict my future choices', that often dying patients lose mental capacity and there is inadequate agreement about 'the meaning of the Mental Capacity Act' [even among the apparently limited number of people who have actually read the Act], and that it is even more complicated when patients are dying at home, and it is easy to see why some HCPs 'are uncertain'.
The LCP seemingly 'failed too often' partly because some of the staff who were using it, had an inadequate understanding of the law for things such as 'best interests decision making', which probably arose because the intention of the LCP, was to try and generate care in non-specialist situations (hospitals) which was more similar to the care in specialist situations (hospices). The LACDP's approach, is in principle better than the LCP was - but, it requires a much deeper understanding in the staff who work with dying patients and with the families and friends of those dying patients.
As Margaret McCartney has just written in her piece about the prescription of Tamiflu:
'But guidelines are not always applicable to our patients, and they are meant to guide practice; rarely should they dictate it.'
I'll stop here: I can either be very brief, or very lengthy, on this particular topic!
This confusion about the LCP's replacement was predictable
It was entirely predictable that the LACDP's 'replacement' for the Liverpool Care Pathway, has confused some healthcare professionals. One reason the LCP was heavily criticised, is that it was [apparently] seen by some HCPs 'as a process into which patients are fitted', whereas good end-of-life care involves fitting the treatment provided to the clinical needs and wider-life requirements of individual patients.
Two patients in identical clinical situations, might have very different objectives and therefore make different choices about which treatments to accept - people are not all alike, 'we are not tins of baked beans'.
So the LACDP effectively said that end-of-life care has to be based on offering the best treatments which can be provided, combined with individual patients making their own choices about which offered treatments to accept: add in that 'I have not died before, so I can't really predict my future choices', that often dying patients lose mental capacity and there is inadequate agreement about 'the meaning of the Mental Capacity Act' [even among the apparently limited number of people who have actually read the Act], and that it is even more complicated when patients are dying at home, and it is easy to see why some HCPs 'are uncertain'.
The LCP seemingly 'failed too often' partly because some of the staff who were using it, had an inadequate understanding of the law for things such as 'best interests decision making', which probably arose because the intention of the LCP, was to try and generate care in non-specialist situations (hospitals) which was more similar to the care in specialist situations (hospices). The LACDP's approach, is in principle better than the LCP was - but, it requires a much deeper understanding in the staff who work with dying patients and with the families and friends of those dying patients.
As Margaret McCartney has just written in her piece about the prescription of Tamiflu:
'But guidelines are not always applicable to our patients, and they are meant to guide practice; rarely should they dictate it.'
I'll stop here: I can either be very brief, or very lengthy, on this particular topic!
Email: mhsatstokelib@yahoo.co.uk
Competing interests: No competing interests