Liverpool Care Pathway for the Dying Patient

{{Short description|Clinical protocol}} {{Use dmy dates|date=April 2022}} {{disputed|date=March 2018}} {{Infobox protocol | name = Liverpool Care Pathway for the Dying Patient | image =  | caption = | standard =  | developer = Royal Liverpool University Hospital | introdate = Late 1990s | industry = Palliative care | connector =  | hardware =  | range =  | newer = Individual approach to end of life care for each patient | website =  }}

The '''Liverpool Care Pathway for the Dying Patient''' ('''LCP''') was a care pathway in the United Kingdom (excluding Wales) covering palliative care options for patients in the final days or hours of life. It was developed to help doctors and nurses provide quality end-of-life care, to transfer quality end-of-life care from the hospice to hospital setting. The LCP is no longer in routine use after public concerns regarding its nature. Alternative methodologies for advance care planning are now in place to ensure patients are able to have dignity in their final hours of life.<ref>{{cite web |title=Universal Principles for Advance Care Planning (ACP) |url=https://www.england.nhs.uk/wp-content/uploads/2022/03/universal-principles-for-advance-care-planning.pdf |website=NHS England |access-date=17 February 2024 |date=March 2022}}</ref> Hospitals were also provided cash incentives to achieve targets for the number of patients placed on the LCP.<ref>{{Cite news|title = Give water to the dying, doctors told {{!}} The Times|url = https://www.thetimes.com/article/give-water-to-the-dying-doctors-told-2nx3xdmtx60|website = The Times|access-date = 2015-12-16| last1=Lay | first1=Kat }}</ref>

The Liverpool Care Pathway was developed by Royal Liverpool University Hospital and the Marie Curie Palliative Care Institute in the late 1990s for the care of terminally ill cancer patients. The LCP was then extended to include all patients deemed dying. Its inflexible application by nursing staff of Liverpool Community Health NHS Trust was subject to scrutiny after the poor care delivered to a relative of Rosie Cooper MP.

While the initial reception was positive, it was heavily criticised in the media in 2009 and 2012 following a nationwide roll-out. In July 2013, the Department of Health released a statement which stated the use of the LCP should be "phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient".<ref name="doh">{{cite web | url = https://www.gov.uk/government/news/overhaul-of-end-of-life-care-system | title = Press release Overhaul of End of Life Care system | work = Department of Health | date = 15 July 2013 }}</ref> However, ''The Daily Telegraph'' reported that the programme was just rebranded and that its supposed replacement would "perpetuate many of its worst practices, allowing patients to suffer days of dehydration, or to be sedated, leaving them unable to even ask for food or drink."<ref name="telegraph_rebranding">{{cite news| last= Donnelly| first= Laura | name-list-style = vanc | url= https://www.telegraph.co.uk/news/health/news/10487109/Liverpool-Care-Pathway-being-rebranded-not-axed.html| newspaper= The Daily Telegraph| title= Liverpool Care Pathway being 'rebranded' not axed| date= 1 December 2014| access-date= 30 July 2018}}</ref>

==Aims== The Pathway was developed to aid members of a multi-disciplinary team in matters relating to continuing medical treatment, discontinuation of treatment and comfort measures during the last days and hours of a patient's life. The Liverpool Care Pathway was organised into sections ensuring that evaluation and care is continuous and consistent. It was not intended to replace the skill and expertise of health professionals.

In the first stage of the pathway a multi-professional team caring for the patient was required to agree that all reversible causes for the patient's conditions have been considered and that the patient was, in fact, dying. The assessment then made suggestions for what palliative care options should be considered and whether non-essential treatments and medications should be discontinued.<ref name=APM/>

In practice, the implementation of this guideline was found to be poor. Many decisions were taken in ward settings without the oversight of experienced doctors of medicine. In almost half of the cases neither patient nor family were consulted or informed that it had been decided to place the patient on the LCP.<ref name="tgf2012-half-never-told">{{cite news| url=https://www.telegraph.co.uk/health/healthnews/9716418/Half-of-those-on-Liverpool-Care-Pathway-never-told.html | archive-url=https://web.archive.org/web/20121203022930/http://www.telegraph.co.uk/health/healthnews/9716418/Half-of-those-on-Liverpool-Care-Pathway-never-told.html | archive-date=3 December 2012 | location=London | work=The Daily Telegraph | first=Laura | last=Donnelly | name-list-style = vanc | title=Half of those on Liverpool Care Pathway never told | date=1 December 2012}}</ref>

The programme suggested the provision of treatments to manage pain, agitation, respiratory tract secretions, nausea and vomiting, or shortness of breath (dyspnoea) that the patient may experience.<ref>{{cite web | url = http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_V12_Core_Documentation_FINAL_%28Example%29.pdf | title = Care for the dying patient | archive-url = https://web.archive.org/web/20121202211908/http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_V12_Core_Documentation_FINAL_(Example).pdf | archive-date = 2 December 2012 | publisher = Marie Curie Palliative Care Institute | work = Liverpool Care Pathway for the Dying Patient (LCP) }}</ref> However, a 2016 Cochrane Systematic Review concluded "there is limited available evidence concerning the clinical, physical, psychological or emotional effectiveness of end-of-life care pathways."<ref>{{cite journal | vauthors = Chan RJ, Webster J, Bowers A | title = End-of-life care pathways for improving outcomes in caring for the dying | journal = The Cochrane Database of Systematic Reviews | volume = 2 | article-number = CD008006 | date = February 2016 | issue = 11 | pmid = 26866512 | pmc = 6483701 | doi = 10.1002/14651858.cd008006.pub4 }}</ref>

The care was not designed to be a one-way street to death. However, in 2012 controversy arose indicating that in most cases it was, and even patients who might have survived longer otherwise died because of the LCP.<ref name=rldt2012/> In a response to negative media reports, Clare Henry and Professor Mike Richards issued a statement on behalf of the NHS End of Life Care Team, stating that the pathway was reversible, and that approximately 3% of patients initially put on the pathway are removed from the pathway when reassessed.<ref>{{cite web | url = http://www.endoflifecareforadults.nhs.uk/assets/downloads/LCP_response_to_media_Oct2009.pdf | title = Liverpool Care Pathway: response to media reporting | archive-url = http://webarchive.nationalarchives.gov.uk/20120831174043/http%3A//www.endoflifecareforadults.nhs.uk/assets/downloads/LCP_response_to_media_Oct2009.pdf | archive-date = 31 August 2012 | work = NHS National End-of-life care programme | date = 15 October 2009 }}</ref>

==Assessment== Initial assessments of the effects and value of the pathway were largely positive. A 2003 study published in the ''International Journal of Palliative Nursing'' found that nurses saw the pathway as having a generally positive effect on patients and their families.<ref>{{cite journal | vauthors = Jack BA, Gambles M, Murphy D, Ellershaw JE | title = Nurses' perceptions of the Liverpool Care Pathway for the dying patient in the acute hospital setting | journal = International Journal of Palliative Nursing | volume = 9 | issue = 9 | pages = 375–81 | date = September 2003 | pmid = 14593273 | doi = 10.12968/ijpn.2003.9.9.11764 }}</ref> A 2006 study published in the same journal found that, despite some "initial scepticism", the doctors and nurses who were interviewed saw the approach as having a valuable place in hospice care, though its use on "dying" patients on general wards was not addressed.<ref>{{cite journal | vauthors = Gambles M, Stirzaker S, Jack BA, Ellershaw JE | title = The Liverpool Care Pathway in hospices: an exploratory study of doctor and nurse perceptions | journal = International Journal of Palliative Nursing | volume = 12 | issue = 9 | pages = 414–21 | date = September 2006 | pmid = 17077800 | doi = 10.12968/ijpn.2006.12.9.21869 }}</ref> A multi-centre study was published in 2008 in the ''Journal of Palliative Medicine'' that found that nurses and relatives thought that the approach improved the management of patients' symptoms, but did not significantly improve communication.<ref name=Veerbeek>{{cite journal | vauthors = Veerbeek L, van Zuylen L, Swart SJ, van der Maas PJ, de Vogel-Voogt E, van der Rijt CC, van der Heide A | title = The effect of the Liverpool Care Pathway for the dying: a multi-centre study | journal = Palliative Medicine | volume = 22 | issue = 2 | pages = 145–51 | date = March 2008 | pmid = 18372379 | doi = 10.1177/0269216307087164 | s2cid = 6848924 }}</ref> The authors concluded that they "consider LCP use beneficial for the care for dying patients and their family."<ref name=Veerbeek/>

A 2009 study published in ''Journal of Pain and Symptom Management'' studied the impact of the pathway on the end-of-life care of over three hundred patients and found that it produced a large decrease in the use of medication that might shorten life and increased patients' involvement in their medication and care.<ref>{{cite journal | vauthors = van der Heide A, Veerbeek L, Swart S, van der Rijt C, van der Maas PJ, van Zuylen L | title = End-of-life decision making for cancer patients in different clinical settings and the impact of the LCP | journal = Journal of Pain and Symptom Management | volume = 39 | issue = 1 | pages = 33–43 | date = January 2010 | pmid = 19892509 | doi = 10.1016/j.jpainsymman.2009.05.018 | doi-access = free }}</ref> A 2009 survey of 42 carers providing the pathway was published in the ''Journal of Palliative Medicine'', it found that 84% were "highly satisfied" with the approach and that it enhanced patient dignity, symptom management and communication with families.<ref>{{cite journal | vauthors = Mullick A, Beynon T, Colvin M, Morris M, Shepherd L, Cave L, Lowell J, Asmall N, Carey I | display-authors = 6 | title = Liverpool care pathway carers survey | journal = Palliative Medicine | volume = 23 | issue = 6 | pages = 571–2 | date = September 2009 | pmid = 19460832 | doi = 10.1177/0269216309106459 | s2cid = 5086172 }}</ref>

Research into its use outside the British healthcare system has not, however, demonstrated the same results: a cluster phase II trial conducted in Italy showed no statistically significant improvement in patients' symptom control.<ref name="Costantini_2014">{{cite journal | vauthors = Costantini M, Pellegrini F, Di Leo S, Beccaro M, Rossi C, Flego G, Romoli V, Giannotti M, Morone P, Ivaldi GP, Cavallo L, Fusco F, Higginson IJ | display-authors = 6 | title = The Liverpool Care Pathway for cancer patients dying in hospital medical wards: a before-after cluster phase II trial of outcomes reported by family members | journal = Palliative Medicine | volume = 28 | issue = 1 | pages = 10–7 | date = January 2014 | pmid = 23652840 | doi = 10.1177/0269216313487569 | s2cid = 206488096 }}</ref> On the other hand, the study did find significant improvements in the other four dimensions it surveyed: respect, kindness and dignity; family emotional support; family self-efficacy; and coordination of care.<ref name="Costantini_2014" />

Jonathan Potter, the director of the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians stated in 2009 that their audits showed that "where the Liverpool Care Pathway for the dying patient (LCP) is used, people are receiving high quality clinical care in the last hours and days of life".<ref name=RCP>{{cite web | url = http://www.mariecurie.org.uk/Documents/HEALTHCARE-PROFESSIONALS/Innovation/generic-NCDAH-round-2-final-report-0210.pdf | title = National care of the dying audit 2009 | work = Royal College of Physicians | date = 14 September 2009 }}</ref> The 2009 audit looked at end-of-life care in 155 hospitals, and examined the records of about 4,000 patients. A major criticism of this study was that each of the participating hospitals was only asked to submit datasets from 30 patients: arguably, the study was heavily biased by the ability to "cherry-pick" the most favourable datasets, and the lack of availability of all data for independent scrutiny and objective assessment.

Version 12 of the LCP was launched on 8 December 2009, after more than two years of consultation. Among other revisions, it includes new decision-making support on whether or not to start the LCP; highlighted guidance to review the appropriateness of continuing on the pathway at any time if concern is expressed by either the patient, a relative, or a team member; and new prompts to support decisions on artificial nutrition and hydration.<ref name="pmid29881785">{{cite journal | vauthors = Seymour J, Clark D | title = The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England | journal = Wellcome Open Research | volume = 3 | page = 15 | date = 2018 | pmid = 29881785 | pmc = 5963294 | doi = 10.12688/wellcomeopenres.13940.2 | doi-access = free }}</ref><ref>{{cite web | first1 = John | last1 = Ellershaw | first2 = Deborah | last2 = Murphy | name-list-style = vanc | url = http://www.liv.ac.uk/mcpcil/pdfs/LCP_Statement_-_Updated_14_Oct_2009%5B1%5D.pdf | title = LCP Statement | date = 13 October 2009 }}</ref> An editorial in the ''BMJ'' judged the new release did "much to tackle recent criticisms".<ref>{{cite journal | vauthors = Edmonds P, Burman R, Prentice W | title = End of life care in the acute hospital setting | journal = BMJ | volume = 339 | article-number = b5048 | date = December 2009 | pmid = 19952043 | doi = 10.1136/bmj.b5048 | s2cid = 30571434 }}</ref>

== Independent review == In July 2013, the results of an independent review into the LCP led by Baroness Neuberger were published.<ref>[https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients Independent report: Review of Liverpool Care Pathway for dying patients] - Department of Health, 15 July 2013.</ref> Accepting the review's recommendations, the government advised that NHS hospitals should phase out the use of the LCP over the next 6–12 months, and that "NHS England should work with clinical commissioning groups (CCGs) to bring about an immediate end to local financial incentives for hospitals to promote a certain type of care for dying patients, including the LCP.<ref name= "doh" />

==Criticism==

===Medical issues===

A 2008 article in the ''American Journal of Hospice and Palliative Care'' criticised the Liverpool Pathway for its traditional approach and not taking an explicit position on the artificial hydration for critically ill patients.<ref>{{cite journal | vauthors = Craig G | title = Palliative care in overdrive: patients in danger | journal = The American Journal of Hospice & Palliative Care | volume = 25 | issue = 2 | pages = 155–60 | year = 2008 | pmid = 18445867 | doi = 10.1177/1049909107312596 | s2cid = 11248472 }}</ref> A 2009 editorial in the ''Journal of Clinical Nursing'' welcomed the impetus towards providing improved care at the end of life and the more widespread use of integrated care pathways, but warned that much more research is needed to assess which of the several approaches that are in use is most effective.<ref>{{cite journal |vauthors=Ingleton C, Gott M, Kirk S |date=April 2009 |title=The beginning of the end (of life care strategy) |journal=Journal of Clinical Nursing |volume=18 |issue=7 |pages=935–7 |doi=10.1111/j.1365-2702.2008.02616.x |pmid=19284430 |doi-access=free}}</ref>

In 2009 ''The Daily Telegraph'' wrote that the pathway has been blamed by some doctors for hastening the death of some mortally ill patients, and possibly masking signs that the patient is improving.<ref>{{cite web | first = Kate | last = Devlin | name-list-style = vanc | url = https://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html | archive-url = https://web.archive.org/web/20090903042850/http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html | archive-date = 3 September 2009 | title = Sentenced to death on the NHS | work = Daily Telegraph | date = 2 September 2009 }}</ref> This story was criticised by the Association for Palliative Medicine and the anti-euthanasia charity Care Not Killing as inaccurate.<ref name=APM>{{cite web | url = http://www.palliative-medicine.org/default.asp | title = The Liverpool Care Pathway | archive-url = https://archive.today/20050415024953/http://www.palliative-medicine.org/default.asp | archive-date = 2005-04-15 | work = The Association for Palliative Medicine of Great Britain and Ireland }}</ref><ref>{{cite web | url = http://www.carenotkilling.org.uk/?show=842 | work = Liverpool Care Pathway | title = Care Not Killing | date = 15 September 2009 }}</ref> In contrast, ''The Times'' welcomed the pathway as an attempt to address patients' wishes and warned about "alarmist" press coverage of the scheme.<ref>{{cite web | first = Joan | last = Bakewell | name-list-style = vanc | author-link = Joan Bakewell | url = http://www.timesonline.co.uk/tol/life_and_style/health/article6832958.ece | archive-url = https://web.archive.org/web/20110604153313/http://www.timesonline.co.uk/tol/life_and_style/health/article6832958.ece | archive-date = 4 June 2011 | title = The Liverpool Care Pathway brings the subject of dying into the open | work = The Times | date = 14 September 2009 }}</ref><ref>{{cite web | first = David | last = Rose | name-list-style = vanc | url = http://www.thetimes.co.uk/tto/health/article1965160.ece | archive-url = https://web.archive.org/web/20121104064915/http://www.thetimes.co.uk/tto/health/article1965160.ece | archive-date = 4 November 2012 | title = The palliative care nurse: some days I wish I worked in a shoe shop | work = The Times | date = 14 September 2009 }}</ref> A German study in 2015 found no indication of hastening death. One in ten patients improves and leaves the pathway. The other nine die.<ref>{{cite journal | vauthors = Schulz C, Schlieper D, Altreuther C, Schallenburger M, Fetz K, Schmitz A | title = The characteristics of patients who discontinue their dying process - an observational study at a single university hospital centre | journal = BMC Palliative Care | volume = 14 | issue = 1 | page = 72 | date = December 2015 | pmid = 26643576 | pmc = 4672507 | doi = 10.1186/s12904-015-0070-7 | doi-access = free }}</ref>

===Media reports=== The LCP has continued to be controversial. Many witnesses have testified that elderly patients were admitted to hospital for emergency treatment and put on the LCP without documented proof that the patient consented to it, or could not recover from their health problem; 48-year-old Norfolk man Andrew Flanagan was revived by his family and went home for a further five weeks after doctors put him on the LCP. The Royal College of Physicians found that up to half of families were not informed of clinicians' decision to put a relative on the pathway.<ref name="Adams2012">{{cite news | last =Adams | first =Stephen | name-list-style = vanc | title = Hospitals 'letting patients die to save money' | url = https://www.telegraph.co.uk/health/healthnews/9385674/Hospitals-letting-patients-die-to-save-money.html | archive-url = https://web.archive.org/web/20120709002431/http://www.telegraph.co.uk/health/healthnews/9385674/Hospitals-letting-patients-die-to-save-money.html | archive-date = 9 July 2012 | work=The Daily Telegraph | date = 8 July 2012 | access-date = 24 July 2012 | location=London}}</ref>

In a 2012 letter to ''The Daily Telegraph'', six doctors belonging to the Medical Ethics Alliance, a Christian medical organisation,<ref name="Adams2012"/> called on LCP to provide evidence that the pathway is "safe and effective, or even required", arguing that, in the elderly, natural death is more often painless, provision of fluids is the main way of easing thirst, and "no one should be deprived of consciousness except for the gravest reason."<ref name=rldt2012>{{cite news |title= Deadly one-way street | vauthors = Millard, P, Cole A, Bearcroft R, Craig G, Hill D, Knowles M |url= https://www.telegraph.co.uk/comment/letters/9385681/Deadly-one-way-street.html|newspaper= The Daily Telegraph|date=8 July 2012 |access-date=10 July 2012 |location=London}}</ref> In response, 1,300 healthcare workers signed a letter to the ''Telegraph'' in support of the LCP, saying it would be the way that they themselves would choose to die.<ref>{{Cite web |last=Adams |first=Stephen |date=2012-11-06 |title=Doctors defend Liverpool Care Pathway as 'dignified' way to die |url=https://www.telegraph.co.uk/news/health/news/9659561/Doctors-defend-Liverpool-Care-Pathway-as-dignified-way-to-die.html |access-date=2024-12-12 |website=The Telegraph |language=en}}</ref>

== Financial inducements to NHS trusts ==

In October 2012 figures released under the Freedom of Information Act showed that some two thirds of NHS trusts had received incentive payments for meeting "targets" for using the LCP, and that such payments totalled £12 million or more.<ref name=telegraph>{{cite web | first = John | last = Bingham | name-list-style = vanc | url = https://www.telegraph.co.uk/health/healthnews/9644287/NHS-millions-for-controversial-care-pathway.html | archive-url = https://web.archive.org/web/20121031234651/http://www.telegraph.co.uk/health/healthnews/9644287/NHS-millions-for-controversial-care-pathway.html | archive-date = 31 October 2012 | title = NHS millions for controversial care pathway | work = The Telegraph | date = 1 November 2012 }}</ref>

== References == {{reflist}}

== Further reading == {{refbegin}} * {{cite journal | vauthors = Ellershaw J | title = Care of the dying: what a difference an LCP makes! | journal = Palliative Medicine | volume = 21 | issue = 5 | pages = 365–8 | date = July 2007 | pmid = 17901095 | doi = 10.1177/0269216307081117 | s2cid = 44627983 | doi-access = free }} * {{cite web | first = James | last = Mulligan | name-list-style = vanc | url = http://archive.catholicherald.co.uk/article/23rd-april-2010/9/a-dependable-pathway-to-the-life-beyond | title = A dependable pathway to the life beyond | work = Catholic Herald | date = 23 April 2010 }}  * {{cite journal | first = Amanda | last = Taylor | name-list-style = vanc | url = https://www.nursingtimes.net/clinical-archive/end-of-life-and-palliative-care/improving-practice-with-the-liverpool-care-pathway-30-08-2005/ | title = Improving practice with the Liverpool Care Pathway | journal = Nursing Times | date = 30 August 2005 | volume = 101 | issue = 35 | pages = 36–7 | pmid = 16161894 }} * {{cite book | last1 = Wilkinson | first1 = Susie | first2 = John | last2 = Ellershaw | name-list-style = vanc |title=Care of the Dying: a pathway to excellence |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2003 |isbn=0-19-850933-2}} * {{cite web | url = https://www.nursingtimes.net/archive/ensuring-people-die-with-dignity-09-12-2008/ | title = Ensuring people die with dignity | work = Nursing Times | date = 9 December 2008 }} {{refend}}

== External links == * {{cite web | url = https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients | title = Report of the Neuberger Review | work = UK Department of Health | date = 15 July 2013 }} * {{cite web | url = http://www.liv.ac.uk/mcpcil/liverpool-care-pathway/ | archive-url = https://web.archive.org/web/20121121105509/http://www.liv.ac.uk/mcpcil/liverpool-care-pathway/ | archive-date = 2012-11-21 | title = Liverpool Care Pathway for the Dying Patient (LCP) | work = Marie Curie Palliative Care Institute | location = Liverpool }} * {{cite web | url = http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_Pocket_Guide_-_April_2010.pdf | archive-url = https://web.archive.org/web/20130301023518/http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_Pocket_Guide_-_April_2010.pdf | archive-date = 2013-03-01 | title = Pocket Guide to the Liverpool Care Pathway for the Dying Patient | work = Marie Curie Palliative Care Institute | location = Liverpool | date = April 2010 }} * {{cite web | url = http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/pdfs/lcpv12newdocuments/LCP%20Relative%20Carer%20Information%20Leaflet%20-%20Nov%2009.pdf | archive-url = https://web.archive.org/web/20120907102923/http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/pdfs/lcpv12newdocuments/LCP%20Relative%20Carer%20Information%20Leaflet%20-%20Nov%2009.pdf | archive-date = 2012-09-07 | title = LCP information leaflet for relatives and carers | work = Liverpool Care Pathway }} * {{cite web | url = http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/What_is_the_LCP_-_Healthcare_Professionals_-_April_2010.pdf | archive-url = https://web.archive.org/web/20120907102858/http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/What_is_the_LCP_-_Healthcare_Professionals_-_April_2010.pdf | archive-date = 2012-09-07 | title = LCP information leaflet for healthcare professionals | work = Liverpool Care Pathway }} * {{cite web | url = http://www.mcpcil.org.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_V12_Core_Documentation_FINAL_(Example).pdf | archive-url = https://web.archive.org/web/20120703135233/http://www.mcpcil.org.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_V12_Core_Documentation_FINAL_(Example).pdf | archive-date = 2012-07-03 | title = LCP standard template, for use in a hospital | date = December 2009 | work = Liverpool Care Pathway }} * {{cite web | url = http://www.cancerhelp.org.uk/help/default.asp?page=23454 | title = What is the Liverpool Care Pathway? | work = Cancer Help UK | date = 5 December 2008 }}

Category:Palliative care in England