To defend the LCP, we need to look at the effects, not the text

First off, I need to say that I support the principle that death is a process that should be managed, and the Liverpool care pathway seems a very sensible document to this purpose.
The Daily Mail, of course, disagrees, and unleashes regular broadsides at the ‘death pathway’.
These articles are accompanied by stories gleaned from disgruntled families and former patients who feel that people are being shunted towards the pearly gates.
One of the most common responses to this from medics, at least on twitter, is to accept that bad things happen but say that it is ‘bad practice’ and nothing to do with the LCP. This won’t do as an argument, I’m afraid.
Policies and pathways do not determine practice, but they do set the context and limits of decision-making, and influence priorities, often in a way that doctors are only dimly aware of themselves.
The LCP, like all pathways, policies and protocols, was written with great care by knowledgeable, careful and humane people, sitting in comfort in air-conditioned meeting rooms, well-rested and alert.
And like all pathways, it is applied by stressed, over-stretched, tired doctors, who for all their dedication and intelligence are precisely as prone to unconscious influence and cognitive bias as anyone else (as research has repeatedly shown).
So it’s not enough to examine the pristine text of the pathway, to defend its implementation we need data and research to show that it helps (which it appears to do).  As Katherine Sleeman put it with acronymic elegance:  we can’t  ignore EBM at EoL.

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5 thoughts on “To defend the LCP, we need to look at the effects, not the text

  1. Jolly well said! How best to acquire that evidence and from who?

  2. I think we need different researchers, rather than more research? The LCP showed no significant improvement in symptoms control in Italy……http://pmj.sagepub.com/content/early/2013/05/03/0269216313487569.abstract ..oddly, ALL of the research showing it improves symptom control has involved people who either work at or trained at MCPiLiverpool ..who own the rights to it. Marketing meets medicine ……

  3. …and, given the dearth of ‘evidence’ ..why on Earth was it recommended by the DoH in the first place…?

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