Here is the structured PICO analysis for the sixty-third article you uploaded:
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Full Title (verbatim and exact):
“Effectiveness of the Liverpool care pathway for the dying in residential care homes: An exploratory, controlled before-and-after study”
Brännström M, Fürst CJ, Tishelman C, Petzold M, Lindqvist O
Palliative Medicine (2016); 30(1):54–63
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Type of Article:
Controlled before-and-after study (quasi-experimental design)
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PICO Analysis:
Population:
- Elderly residents in 19 residential care homes (RCHs) in a Swedish municipality
- 837 patients died during the 29-month study period (mean age ~86 years), mostly from cardiovascular diseaseor dementia-related causes
- Family members of deceased residents completed symptom assessments using validated retrospective tools
Intervention:
Liverpool Care Pathway (LCP) for the Dying Patient, Swedish version (v11), introduced in 10 of the 19 RCHs
- Staff in the intervention area received:
- A 3-hour education session in end-of-life care and the LCP
- Web-based “train-the-trainer” training for contact RNs
- Regular follow-up meetings to support LCP use
- The LCP provided a structured tool for recognising dying, managing symptoms, and communicating with family
Comparator:
- Usual care provided in the 9 RCHs in the control area
- Both intervention and control areas received a general 2 × 3.5-hour training on end-of-life care prior to the study
Outcome:
1. Person-centred outcomes:
- Primary outcome: Symptom distress in the last 3 days of life, measured by:
- Edmonton Symptom Assessment System (ESAS): pain, breathlessness, nausea, fatigue, anxiety, etc.
- VOICES questionnaire: family-reported views on end-of-life symptoms and care quality
- Significant improvements in the intervention group:
- Shortness of breath (ESAS: –2.46 points, p=0.016; VOICES also significant)
- Nausea (ESAS: –1.83 points, p=0.007)
- Trends toward improvement in pain, well-being, and depression, but not statistically significant
2. Process outcomes:
- LCP was completed for 60% of eligible patients in the intervention group
- Barriers to implementation included:
- Sudden death
- Deaths in hospital
- GP reluctance
- Lack of time or off-hours availability
- LCP was used for an average of 67 hours prior to death
3. Health system outcomes (proxy):
- No direct data on hospitalisations, costs, or length of stay
- However, greater response rate to bereavement surveys in the intervention group may reflect improved family experience
- Policy impact: Based on the study’s implementation experience, the municipality adopted LCP for routine end-of-life care in all RCHs
Summary Conclusion:
This exploratory controlled study suggests that the Liverpool Care Pathway (LCP), when implemented with staff training and local leadership, may improve end-of-life symptom management—specifically reducing breathlessness and nausea—for elderly people dying in residential care homes. The findings support the feasibility and potential value of LCP in non-cancer, community-based aged care, though the study design limits generalisability. Future research should use randomised designs and explore resident-centred and health system-level outcomes.
Life In The Slower Lane 
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