Doing the right thing at the right time

Area of Science:

• Palliative Care
• End-of-Life Care
• Clinical Decision-Making

Background:

• Improving care for dying patients and families is crucial.
• Timely identification of dying patients is necessary for effective care.
• The Liverpool Care Pathway (LCP) aims to enhance end-of-life care.

Purpose of the Study:

• To identify factors clinicians consider when diagnosing a dying patient.
• To inform the appropriate implementation of the Liverpool Care Pathway.

Main Methods:

• Phenomenological study design.
• Semi-structured interviews with ten clinicians (five nurses, five doctors).
• Interviews conducted on a hospice inpatient unit.

Main Results:

• Clinicians expressed anxiety regarding the accurate timing of diagnosing dying.
• Key identified factors include: support for decision-making, understanding the patient's journey, and ensuring appropriate care.
• Concerns were raised about increasing patient/carer distress if LCP implementation is mistimed.

Conclusions:

• Mistimed Liverpool Care Pathway implementation risks increasing patient and carer distress.
• Potential exists for clinicians to avoid difficult conversations with families.
• Enhanced communication training may improve the understanding and use of the Liverpool Care Pathway.