End-of-life care pathways for the dying

Chan R, Webster J

Published Online:

March 16, 2011

End-of-life pathways are used for people who are in the last days of their life to guide care; aid decision making; and provide efficient care. This review examined whether using end-of-life care pathways in caring for the dying was effective. No studies meeting the inclusion criteria were found that used an end-of-life care pathway in caring for the dying. Therefore, there is insufficient data at present to make recommendations regarding the use of such end-of-life care pathways for the dying.

Abstract (click to read)

Background:

In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems. Particularly, care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. They aim to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. Therefore, there is a significant need for clinicians to be informed about the utilisation of end-of-life care pathways with a systematic review.

Objectives:

To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community).

Search strategy:

The Cochrane Register of controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register, MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The search was carried out in September 2009.

Selection criteria:

All randomised controlled trials (RCTs), quasi-randomised trial or high quality controlled before and after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying.

Data collection and analysis:

Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors.

Main results:

The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review.

Authors' conclusions:

Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. RCTs or other well designed controlled studies are needed for evaluating the use of end-of-life care pathways in caring for dying people.

This record should be cited as:

Chan R, Webster J. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD008006. DOI: 10.1002/14651858.CD008006.pub2

Assessed as up to date:

September 7, 2009

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Primary Review Group:

Pain, Palliative and Supportive Care Group

Health topics:

Cancer > Palliative and supportive care > Organization of care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

End-of-life care pathways for the dying

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