End-of-life communication: let’s talk about death

How do we improve care for the dying in hospital? Around half of all deaths in the UK occur in hospitals and surveys of the bereaved consistently report that the quality of end of life care is poorer in hospitals than hospices. The Liverpool Care Pathway (LCP) was developed in the late 1990s to bridge this gap, and was rapidly promoted as a model of good practice. However, this rapid promotion occurred in the absence of strong evidence of its benefits. What evidence there was came from quasi-experimental (non-randomised) studies, and audits that measured processes of care (e.g. whether opioids were prescribed) but not patient outcomes (e.g. whether patients' pain improved). 1 This created a Catch-22 situation: once the LCP became accepted as a gold standard it was almost impossible to test it in a comparative study.