End-of-life care pathways

A tool to guide quality end-of-life (terminal) care

An end-of-life care pathway is a tool which outlines what is recognised as best practice for a holistic, person-centred approach to end-of-life care and dying.

An end-of-life care pathway guides and monitors a person’s journey of care between health professionals and across settings. It can help prompt terminal care and encourage discussion with the person and their family. It can guide appropriate and timely prescribing and decision-making.

End-of-life care pathways use documents, sometimes flowcharts, to outline the steps of care to be followed by members of multidisciplinary teams.

They support clinical judgement but do not replace it.

When implementing a care pathway, remember to discuss it with the person and their family, and ensure that doctors and other health professionals caring for the person are aware of this. Discuss any changes or concerns that you may have about the person’s care and remember that a person can come off a pathway.

Guidelines and pathways that are available to guide decision-making in end-of-life care include:

• Care at End of Life Project, Department of Health and Aged Care. Care Plan for the Dying Person - Health Professional Guidelines February 2019 (756kb pdf). Brisbane: Queensland Health; 2019.
• Residential Aged Care End of Life Care Pathway (RAC EoLCP)
• Gold Standards Framework (UK) provides an evidence-based approach to optimising care for people nearing the end of life.

A word about EOL care pathways

Care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. The Liverpool Care Pathway for the Dying Patient (LCP) is the most widely recognised and acknowledged integrated care pathway, and has been utilised and modified across the world.

In 2013 stories in the press and broadcast media concerning the LCP in the UK were highlighting where care had not been optimal and rather than initiate conversations with families and with each other, staff had taken a tick box approach. A review was subsequently undertaken, led by Baroness Julia Neuberger (chair) with over 40 recommendations for change.

However, LCP was also adapted and implemented in 20 countries often with assistance from the Liverpool team. [1] This was frequently based on a ‘plan’, ‘do’, ‘study’, and ‘act’ approach to encourage monitoring and evaluation, and with an improved outcome compared to the UK. According to the very extensive review of Clark et al some of the most rigorous implementation research into the LCP was conducted by a cluster of nine countries including Australia and Italy. [1] Collectively the experiences in these countries were regarded as successful although effectiveness was not uniformly demonstrated under controlled conditions. Tailored EoLCPs continue to be implemented in a number of countries reportedly without the problems encountered in the UK.

It is worth noting that no pathway is set in stone. None of them should be prescriptive to the exclusion of common sense (and a patients’ changing condition). If this is the case, then inappropriate treatment and care can take place. Pathways, guidelines or frameworks should not take the place of impeccable assessment / re-assessment.