The authors declare that they have no competing interests.
RV conducted the phase 0–1 study in collaboration with TS, JC, MC, NVDN, AVDH, and LD. Regarding the preclinical phase, RV, and TS reviewed the existing LCP programmes and RV performed the literature review to identify key factors for a successful LCP implementation. All authors were involved in the analysis of the concerns regarding the use of the LCP in the UK. MC and NVDN were two of the clinicians, ie an oncologist, and a geriatrician, with whom the raised concerns were subsequently discussed. All authors were involved in the modelling phase. RV developed the preliminary programme in collaboration with TS which was refined after review by and discussion with NVDN, MC, JC, AVDH, and LD. RV wrote the initial draft of the manuscript. All authors commented critically on several drafts of the manuscript and have approved the final version.
The effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the UK hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards.
We conducted a phase 0–1 study according to the Medical Research Council Framework. Phase 0 consisted of a review of existing LCP programmes from the UK, Italy, and the Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, we developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. The care programme was reviewed and refined by two nurses and two physicians working in an acute geriatric ward and by two experts from Italy and the Netherlands.
Phase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation and a summary of the LCP concerns raised in the UK. Based on these findings we developed a new care programme consisting of (1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward, (2) supportive documentation, and (3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.
Based on the existing LCP programmes and taking into account the key factors for successful LCP implementation as well as the concerns raised in the UK, we developed a care programme for the last days of life and modelled it to the acute geriatric hospital wards after gaining feedback from health professionals caring for older hospitalized patients.
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- Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework
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