Monday, 4 February 2013

Liverpool Care Pathway - This Is The DCP

The LCP is an EoL tool developed in consort with the University of Liverpool.

The DCP is an EoL tool developed in consort with the University of Dundee.

The casual assumption - and it is understandable - might be that DCP stands for Dundee Care Pathway. If you have formed that assumption, you would be wrong. The DCP is the Dignity Care Pathway.

This is the QNIS Project Report -


Final Project Report
Dignity Conserving Intervention - Developing and testing a dignity conserving 
intervention for people with advanced illness at the end of life
QNIS Reference number EJDCI01

Report prepared by Dr Bridget Johnston- first author and grant holder with 
input from Hilary Brown and Dr Ulrika Ostlund
13th January 2011

This intervention study was underpinned by the UK Medical Research Council (MRC) complex intervention framework. The study designed, tested and implemented an intervention developed by the authors, the Dignity Care Pathway (DCP). The DCP is designed for use by community nurse caring for patients nearing the end of life at home. The DCP is based on the theoretical model developed by Chochinov (Chochinov et al. 2002). 
The Patient Dignity Inventory (PDI) developed by (Chochinov et al.2008) was used to identify dignity related distress and key concerns from the patient viewpoint The Reflective questions and care actions in the DCP were evidenced from a systematic literature review and focus group interviews with patients, carers, and HCPs.

What is PDI?

This is PubMed -

 2012 Sep;15(9):998-1005. doi: 10.1089/jpm.2012.0066.

The Patient Dignity Inventory: applications in the oncology setting.


Department of Psychiatry, Manitoba Palliative Care Research Unit, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.



The Patient Dignity Inventory (PDI) is a novel 25-item psychometric instrument, designed to identify multiple sources of distress (physical, functional, psychosocial, existential, and spiritual) commonly seen in patients who are terminally ill. It was also designed to help guide psychosocial clinicians in their work with patients. While its validity and reliability have been studied within the context of palliative care, its utility in clinical settings has not as yet been examined.


The purpose of this study was to determine how psychosocial oncology professionals would use the PDI with within their practice and what utility it might have across the broad spectrum of cancer.


Between October 2008 and January 2009, psychosocial oncology clinicians from across Canada were invited to use the PDI to determine their impressions of this approach in identifying distress and informing their practice.


Ninety participants used the PDI and submitted a total of 429 feedback questionnaires detailing their experience with individual patients. In 76% of instances, the PDI revealed one or more previously unreported concerns; in 81% of instances, clinicians reported that the PDI facilitated their work. While it was used in a wide range of circumstances, clinicians were more inclined to apply the PDI to patients engaged in active treatment or palliation, rather than those in remission, having recently relapsed, or newly diagnosed. Besides its utility in identifying distress, the PDI enabled clinicians to provide more targeted therapeutic responses to areas of patient concern.


While this study suggests various clinical applications of the PDI, it also provides an ideal forerunner for research that will directly engage patients living with cancer.
[PubMed - indexed for MEDLINE]

The PDI (Patient Dignity Inventory) is a novel psychometric designed to measure various sources of dignity-related distress among patients nearing the end of life. [The Patient Dignity Inventory: A Novel Way of Measuring Dignity-Related Distress in Palliative Care]

The PDI is a 25-item psychometric instrument or questionnaire.

What is a psychometric questionnaire?


Psychological tests (see psychological testing) are used both to generate empirical data on mental processes and to refine their understanding of measurement techniques and the statistical analysis of results. Major concerns include test reliability and validity and the norming or standardization of results. [psychometrics (Concise Encyclopedia)]

Psychological testing, also called psychometrics, the systematic use of tests to quantify psychophysical behaviour, abilities, and problems and to make predictions about psychological performance. [Britannica] 

Psychometric testing is also a tool devised by Ron L Hubbard and used by the Church of Scientology.

The DCP "was acceptable to the community nurses, helped them identify when patients were at the end of life..." [Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life.

"Nurses identified that using the DCP allowed them to reconsider which patients required palliative care.  In line with Scottish Government (Scottish Government 2008) policy, this study encouraged nurses to consider approaching any patient who the nurse considered was in the last months of their illness, regardless of diagnosis, and including the frail elderly."
[PAGE 12 - QNIS Project Report]

"The community nurse makes a prognostic, clinical judgment to decide when to start a patient on the DCP..." [Dignity in End-of-Life Care]

The Pathway, clearly, is a multi-headed Hydra that, whatever the outcome of the current review, is determined to outlive us all.

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