Date of Award

2021

Degree Name

Master of Medicine / Surgery (Thesis)

Schools and Centres

Medicine

First Supervisor

Richard Chye

Second Supervisor

Liz Lobb

Abstract

The care towards the end of life is an important aspect of patient management. There is a recognised need to support healthcare providers in caring for dying patients in the acute hospital.(1-5) The Liverpool Care Pathway was originally designed to provide guidance in the delivery of comprehensive palliative care in the last days of life. However, there are no robust clinical data supporting the use of the Liverpool Care Pathway despite its widespread implementation worldwide.(6, 7)

This study investigated whether implementation of an end of life care pathway, adapted from the Liverpool Care Pathway, increases the frequency of prescriptions of pre-emptive and as-required symptom control medications in acute inpatients during the terminal phase and compared the result against inpatients who died in a hospice.

This study found that dying in the hospice and receiving specialist palliative care input was associated with a higher rate of being prescribed recommended as-required end of life medications. In patients who did not receive specialist palliative care input, being in the acute hospital with an end of life care pathway was associated with a higher rate of being prescribed pre-emptive as-required end of life symptom control medications. Therefore, the implementation of an end of life care pathway did improve an aspect of terminal care in acute hospital to match the standard of care. However, in view of increasing literature examining the practices in palliative care, the end of life care pathway will require close monitoring and regular updating by specialists in palliative care to ensure that was recommendations reflect the current literature.

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