Using end of life care pathways for the last hours or days of life

There is international consensus about the importance of achieving a “good death” that is comfortable, dignified, and person centred.1 But controversy persists about the benefits and hazards of using an integrated care pathway to support the care of people who are expected to die soon. National end of life care programmes, in the United Kingdom and internationally, endorse tools designed to improve standards of care for people dying in the community, care homes, and hospitals.2 Following more than a decade of development and implementation in many countries, the Liverpool Care Pathway is one of the most widely used of these tools.3 It has recently become a focus for wider societal, ethical, and professional debates about identification of patients who are dying and shared decision making at the end of life.

The Liverpool Care Pathway is a structured clinical record that aims to support clinical judgment and assist multidisciplinary teams in providing optimal treatment and care for patients who are dying. It encompasses evidence based control of pain and symptoms, holistic care for patients and families, and good communication. Consistent, high quality care is achieved through timed reviews of the patient’s comfort and documentation …