Life In The Slower Lane

Certainly. Below is a 10-point summary of the Cochrane Review titled:

“End-of-life care pathways for improving outcomes in caring for the dying”

(Chan RJ, Webster J, Bowers A. Cochrane Database Syst Rev. 2016; Issue 2: CD008006)

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🔟 Key Summary Points

1. Objective:The review aimed to assess the effects of end-of-life care pathways (EoLCPs) on symptom control, quality of life, and experiences of dying patients and their carers, compared to usual care or alternative pathways.
2. Scope and Methods:A comprehensive search of five major databases (CENTRAL, MEDLINE, EMBASE, PsycINFO, and CINAHL) up to July 2015 yielded over 3000 titles. After screening, only one study met the inclusion criteria.
3. Included Study:The review included a single cluster randomised controlled trial (Costantini et al. 2014) involving 16 Italian hospital wards and 232 family carers of cancer patients. The intervention used the Italian version of the Liverpool Care Pathway (LCP-I).
4. Key Findings (Effectiveness):
   • Breathlessness: modest improvement in control (OR 2.0, 95% CI 1.1–3.8)
   • Pain and nausea: no significant difference compared to usual care
   • Other outcomes (psychological distress, quality of life, harms, satisfaction, costs) were not assessed
5. Implementation Issues:Only 34% of patients in the intervention group were actually cared for using the pathway—indicating low fidelity in implementation.
6. Risk of Bias:The included study was judged to be at high risk of bias due to:
   • Lack of blinding
   • Incomplete data
   • Imbalance in follow-up between groups
   • Unclear allocation concealment
7. Certainty of Evidence:Overall, the evidence was rated very low quality due to methodological limitations, imprecision, and limited generalisability.
8. Generalisability Limits:The findings apply only to hospital-based care for dying cancer patients in Italy, and cannot be generalised to other settings (e.g. RACFs, community) or to non-cancer populations.
9. Authors’ Conclusions:There is insufficient evidence to support or refute the clinical effectiveness of end-of-life care pathways. Their routine use cannot be recommended without further evaluation.
10. Policy and Research Implications:The authors advised:

• Caution in pathway implementation given resource intensity and weak evidence
• Urgent need for high-quality RCTs across diverse settings and populations
• Emphasis on measuring patient, family, and system-level outcomes in future research

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