Palliative care for older people - World Health Organization ...

14Integrated care pathwaysCare pathways are structured multidisciplinarycare plans that detail essential steps in the care ofpeople with a specific clinical problem and describetheir expected clinical course (1).They can provide a link between the establishmentof clinical guidelines and their use and can help incommunicating with the people who need care bygiving them access to a clearly written summary oftheir expected care plan and progress over time.Care pathways can help promote teamwork andpatient-centred care.Such care pathways for palliative and end-oflifecare have been developed in several countries,including for inpatients (2) and oncology units(3) in the United States of America and in othersettings (4).© Joan TenoBox 14.1. Liverpool Care Pathway for the Dying PatientThe Liverpool Care Pathway (LCP) has been developed in the United Kingdom to transfer the hospice modelof care for people who are dying into other care settings (5). The pathway has been modified for people withother conditions, such as kidney disease, heart failure and dementia (6) and has been successfully disseminatedin 18 countries outside the United Kingdom. The LCP has been adapted to Australia’s health care setting (7)and has been successfully implemented in the Hong Kong Special Administrative Region of China (8). The LCPhas been translated into Dutch and tested in three settings in the Netherlands: hospital, nursing homes andhome care (9). Everyone in the dying phase was put on the pathway. During the period when the pathwaywas being used, documentation of care was more comprehensive and there was a reduction in the symptomsas reported by staff or bereaved relatives. The LCP is now being tested for effectiveness in a multicentrerandomized controlled trial in six regions of Italy.Source: personal communication, Massimo Costantini, Regional Palliative Care Network, National Institute for Cancer Research, Genoa, Italy.44