The withdrawal of the Liverpool care pathway in the United Kingdom: What are the implications for Australia?

Integrated care pathways are documents that outline the essential steps of multidisciplinary care in dealing with a specific clinical problem. They can be used to introduce best clinical practice, to ensure that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. By providing clear instructions, decision support and a framework for clinician–patient interactions, care pathways guide the systematic provision of best evidence-based care. The Liverpool Care Pathway for the Dying Patient (LCP) is an example of an integrated care pathway — it was designed in the United Kingdom in the 1990s to guide care for people with cancer who were in their last days of life and expected to die in hospital. This pathway evolved out of a recognised local need to better support non-specialist palliative care providers to care for patients dying of cancer in their inpatient units. Historically, despite the many people in acute care settings whose treatment intent was palliative,4 dying patients in these settings tended to receive insufficient attention from senior medical and nursing staff.5 As the quality of end-of-life care was considered inadequate, much could be learned from the way patients were cared for by palliative care services.5 The LCP was a strategy to improve this end-of-life care and was based on the care received by those dying in the palliative care setting.