ArticleBMJ open2015
'It doesn't do the care for you': a qualitative study of health care professionals' perceptions of the benefits and harms of integrated care pathways for end of life care.
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Exploring clinician perceptions of a care pathway for the management of shoulder pain: a qualitative study.BMC health services research · 2022Article
- Natural language word embeddings as a glimpse into healthcare language and associated mortality surrounding end of life.BMJ health & care informatics · 2021Article
- Documenting plans for care: advance care directives and the 7-step pathway in the acute care context.BMC palliative care · 2021Article
- Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand.BMC health services research · 2021Article
- Article
- Impact of the Liverpool Care Pathway on quality end-of- care in residential care homes and home care-Nurses' perceptions.Nursing open · 2019Article
- How can end of life care excellence be normalized in hospitals? Lessons from a qualitative framework study.BMC palliative care · 2018Article
- Electronic Implementation of Integrated End-of-life Care: A Local Approach.International journal of integrated care · 2017Article
- Organization-level principles and practices to support spiritual care at the end of life: a qualitative study.BMC palliative care · 2017Article
- The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories.BMC anesthesiology · 2016Article
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Authors and funding
13 authors.
Funding
Abstract
objectivesTo understand healthcare professionals' perceptions of the benefits and potential harms of integrated care pathways for end-of-life care, to inform the development of future interventions that aim to improve care of the dying.
designQualitative interview study with maximum variation sampling and thematic analysis.
participants25 healthcare professionals, including doctors, nurses and allied health professionals, interviewed in 2009.
settingA 950-bed South London teaching hospital.
results4 main themes emerged, each including 2 subthemes. Participants were divided between (1) those who described mainly the benefits of integrated care pathways, and (2) those who talked about potential harms. Benefits focused on processes of care, for example, clearer, consistent and comprehensive actions. The recipients of these benefits were staff members themselves, particularly juniors. For others, this perceived clarity was interpreted as of potential harm to patients, where over-reliance on paperwork lead to prescriptive, less thoughtful care, and an absolution from decision-making. Independent of their effects on patient care, integrated care pathways for dying had (3) a symbolic value: they legitimised death as a potential outcome and were used as a signal that the focus of care had changed. However, (4) a weak infrastructure, including scanty education and training in end-of-life care and a poor evidence base, that appeared to undermine the foundations on which the Liverpool Care Pathway was built.
conclusionsThe potential harms of integrated care pathways for the dying identified in this study were reminiscent of criticisms subsequently published by the Neuberger review. These data highlight: (1) the importance of collecting, reporting and using qualitative data when developing and evaluating complex interventions; (2) that comprehensive education and training in palliative care is critical for the success of any new intervention; (3) the need for future interventions to be grounded in patient-centred outcomes, not just processes of care.
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