Outcome evaluation of introducing the Japanese version of the Liverpool Care Pathway for patients with cancer in a general ward

This study sought to determine whether the Japanese version of the Liverpool Care Pathway （LCP-J） could improve nurses’ practice in dying-phase and difficulties with palliative care in a general ward. Between July 2014 and June 2015, LCP-J intervention and educational program for nurse were introduced in a general ward. The primary aims of this study were to clarify the changes in self-reported practice and difficulties of nurse before and after the interventions. Self-reported practice and difficulties were measured using Palliative Care Self-Reported Practice Scale （PCPS） and Palliative Care Difficulty Scale （PCDS）, respectively. The secondary aim was to clarify the defference in treatment, care and examination within last 48 hours between LCP-J patients and non-LCP-J patients. We obtained 21 responses in pre-intervention and 22 responses in post-intervention surveys from eligible nurses. Significant improvements were noted on domain of dying-phase care in PCPS and domain of alleviation of symptom in PCDS （3.00±1.16 versus 3.52±0.61 [p=0.042], 3.56±0.78 versus 3.10±0.63 [p=0.015], respectively）. LCP-J was used for 9 dying cancer patients （40%）, and no significant difference in treatment and examination within last 48 hours between LCP-J patients and non-LCP-J patients. LCP-J in general ward may improve nurses’ practice in dying-phase and difficulties with alleviation of symptom. In addition, considering the burden of LCP-J, to develop a useful checklist and educational interventions for dying patients is promising.

A retrospective study between use and not－use of the Japanese version of the Liverpool Care Pathway

<b>Purpose:</b> To investigate the indications for use of the Japanese version of the Liverpool Care Pathway (LCP), we evaluated the conditions of patients using and those not using the LCP. <b>Methods:</b> We retrospectively investigated the medical records of 71 LCP patients and 60 non－LCP patients who died in our palliative care unit between March and December 2013. <b>Results:</b> There was no significant difference in patients’ background between the LCP and non－LCP groups. For patients in the non－LCP group, sudden changes in condition were significantly more frequent and deep continuous sedation was used significantly less than in the LCP group. In the LCP group, the average duration on the LCP was 4.0 days, and the beginning criterion was met by three－point or more of all the patients. The initial assessment was achieved except for one case. In the non－LCP group, reasons for not using the LCP were a sudden change in condition (35 patients), a rapid change in medical condition (14), and a risk of falling (4). <b>Conclusions:</b> The LCP met the beginning criterion and was started at suitable time in the LCP group. The LCP is not useful for all patients; it cannot be used for a patient with sudden or rapid changes in condition, or at a risk of falling.

The significance and possibility of introduction of a Japanese language version of the Liverpool Care Pathway for the Dying Patient: The pilot study in the two palliative care units

<b>Purpose</b>: The Liverpool Care Pathway is a clinical path for the dying patient. In this study, a pilot study of a Japanese language version of the Liverpool Care Pathway Powered by Editorial Manager® and Preprint Manager® from Aries Systems Corporation (henceforth, “LCP”) was carried out in order to investigate the significance of using LCP and the possibility of its introduction. <b>Method</b>: 1. LCP was used on inpatients in the palliative care wards, and the status of the achieved care goal was evaluated. 2. A questionnaire survey regarding the usefulness of LCP was conducted on the nursing staff of the study facility. <b>Results</b>: The care goal indicated by LCP were achieved in 80% or more of the patients and families. The nursing staff members were asked to evaluate of LCP was evaluated the usefulness of LCP in confirming that the patient is in the dying phase, reviewing end-of-life care, continuous integrated care giving, and education for nurses with limited experience with end-of-life care. <b>Conclusion</b>: The high degree of achievement of the care goal in LCP shows concordance between LCP and end-of-life care at the study facility, and shows that it is possible for LCP to be introduced as an index of clinical pathway for end-of-life care giving. In addition, the nurses' evaluations imply the significance of LCP in reinforcement and education with regard to end-of-life care giving.