Palliative essay - Innovations in Palliative Care

In contemporary society, the modern innovations in palliative care have greatly
assisted in the improvement of the quality of life; as well as a reduction of
suffering for patients with a life limiting illness. Innovations can be defined as
practices that are considered new, and those that have been constant for a
period of time in one or various parts of the world; however, are yet to be
implemented or established in other areas (Gené-Badia, 2001). The purpose of
this essay is to demonstrate insight into how the Liverpool Care Pathway (LCP),
an innovation in palliative care has assisted individuals with cancer, within the
areas of the quality of life and reduction of suffering.
This essay will identify the palliative population that will be assisted from the
LCP, stipulate an explanation for the solutions presented by LCP, study aspects
which have contributed to barriers in the execution of the innovation and
conclusively validate how LCP has impacted on the palliative patient.
LCP intends to assist the improvement of care and communication in the dying
phase of the patient (Veerbeek et al., 2008), the development of LCP was to
incorporate best hospice care to hospitals and similar healthcare facilities; the
usage of LCP is within a specific time frame, which is the last days or hours of
life once it becomes known, that the patient is dying (Knights et al., 2013).
The LCP entails encouragement of good quality communication with both the
patient and family, proactive planning inclusive of psychosocial and spiritual
requirements, symptom control such as pain and the care after the death
(Knights et al., 2013).

The LCP is an integrated care pathway to offer guidance, on the care of dying
patients and their families whilst additionally, supporting the provision of
measurable results of care; for instance, symptom management (Ellershaw et
al, 2001) as cited in (Anderson, Annie, & Chojnacka, 2012).
The LCP is a lawful document that reinstates all types of paperwork when a
conclusion of the dying has been produced (Anderson, Annie, & Chojnacka,
2012). The recommendation of LCP, as a means to aid the delivery of high-level
quality care to dying patients, is demonstrated in current literature; used by the
complete members of the multidisciplinary team with plans to inspire a higher
level of continuity of care (Anderson, Annie, & Chojnacka, 2012).
A crucial concern while addressing the requirements of a patient, in the
terminal stage of cancer is symptom management; the pain and sickness can
instigate distress to the patient and their relatives, which implies symptom
management in end of life care, demanded to be enhanced (Ellershaw &
Wilkinson, 2010).
(Ellershaw & Wilkinson, 2010) found over fifty percent of dying patients suffered
episodes of pain for the duration of the last forty eight hours of life, in order to
manage pain and other symptoms nurses must be competent in pain
assessment; the assessment of pain and the pain medication flowchart
incorporated in the LCP, offers clinicians with guidelines to support them in
conversing with patients, when possible and their relatives of carers, about the
patients’ worsening state and imminent bereavement (Anderson, Annie, &
Chojnacka, 2012).

The guidelines support practitioners in certifying the accurate level of
information is given at the appropriate time, and the opportunity for discussion is
permissible; correspondingly, the pain medication flowchart encompassed
within the LCP supplies clinicians with a mechanism to evaluate pain efficiently
(Anderson, Annie, & Chojnacka, 2012).
One recent study found participants concurred that LCP documentation was
vastly beneficial, as the decrease in paperwork permitted practitioners to devote
supplementary time with patients; furthermore, partakers also saw LCP
documentation made it simpler to attain swift access to particulars, including
next of kin and spiritual needs (Anderson, Annie, & Chojnacka, 2012).
The research also suggests the participants coincided that the LCP was a
valuable guide following demise, offering instructions in addition to acting as a
remembrance aid; subsequently all kin had all the indispensable information
(Anderson, Annie, & Chojnacka, 2012).
The literature indicates the LCP had a constructive outcome on two parts of
documentation; first by the replacement of all clinical documentation through a
sole care pathway which empowers clinicians to work proficiently as a
multidisciplinary team hence the decrease of needless paperwork and extra
time with patients. Moreover, the LCP demonstrates the improvement of the
documentation of care, that is presented to the individual consequently,
proposing prompts and support for other associates of the team (Anderson,
Annie, & Chojnacka, 2012).

The practice of LCP received high level commendation in 2005 from the
‘National Council for Palliative Care’ and was endorsed by the momentous
‘National End of Life Care Strategy’, circulated in 2008; at this stage, the LCP
appeared to have become definitely reputable: strategically, clinically,
organisationally (Seymour & Clark, 2018).
The discussion around the LCP has depicted a hesitancy in society to report
topics of mortality, by individuals, loved ones and practitioners alike; since
hospitals are understood as places that rectify and extend life whereas
acceptance of dying is construed as giving up (Knights et al., 2013).
Numerous impediments to the implementation of the LCP have been revealed,
which incorporate the occurrence of other urgencies in the establishment, a
project team with unsatisfactory authority, limited bereavements to advance
adequate knowledge and proficiency; project teams with only clinicians deprived
of a member of management, were not able to distribute the LCP into the
organisation and warrant incessant practice (Raijmakers et al., 2014)
Unfortunately, the media has emphasised instances of mediocre practice,
various situations uncovered ineffectual interaction concerning practitioners and
relatives; causing in appalling care (Knights et al., 2013). Although, the LCP
constantly accentuated the significance of clear and open communication for
the kin and patient as well as the multidisciplinary team; it stipulates structure to
aid novice or anxious experts with challenging parts of communication (Knights
et al., 2013) (Knights et al., 2013).

One issue mentioned was articles of patients being refused oral fluids, when the
LCP was unequivocal that the patient must be encouraged to consume
nourishment and fluid by mouth for as long as endured; it was apparent that
reports also recognised removal of hydration and sustenance by drip or tube,
with no discussion when in fact the LCP states many patients may not need
aided nourishment or hydration and the care plan must be elucidated to the
patient or suitable individual (Knights et al., 2013).
Results from multiple qualitative research, recommend the LCP can enhance
considerably and over long term, the value of palliative care distribution in
healthcare environments (Costantini et al., 2011). (Mayland et al., 2013), has
found within the healthcare setting, the LCP is successful in developing
specialised facets of care such as symptom control. One study conducted by
(van der Heide et al., 2010) retrieved data demonstrated the patient discussed
wishes concerning the medical treatment with the practitioner, nurse or family;
and a quarter of the patients in the study conveyed discussions of preferences
such as: abstention from life lengthening dealings, yearning for adequate
symptom control and the prospect of euthanasia were appreciated.
Literature on LCP has shown an affect on the reduction of medication, that
would have normally had a potential to shorten the patient’s life; the statistics
show from forty six percent to twenty eight percent (van der Heide et al., 2010).
Additionally, the life shortening medications were provided after an explicit
request or permissions from the patient after LCP was introduced (van der
Heide et al., 2010)

The LCP is proven to be an innovation in palliative care, has assisted
individuals with cancer, within the areas of the quality of life and reduction of
suffering.

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