Liverpool Care Pathway - Many Fingers In The Pot

This is from the NCPC website -

Dying Matters – raising public awareness

In 2008 the government published the End of Life Care Strategy for England, in which NCPC was invited to lead a national coalition to increase public awareness, discussion and debate around dying, death and bereavement. NCPC accepted the challenge and in 2009 the Dying Matters Coalition was born. In a short time the coalition has become established and respected and now boasts over 16,000 members. Whilst the Dying Matters Coalition’s main focus is England, we support and encourage better public awareness across the UK.

NCPC today

NCPC celebrated its 20th birthday in 2011 and is going from strength to strength. We produce a range of publications, leaflets, DVDs, conferences and training programmes to help our subscribers around the country deliver the best levels of care. We work with government, the NHS, the voluntary and private sectors to shape future strategies and plans. We involve patients, carers and families in everything we do to ensure our work is informed by people with real experience.

Is this a 'junior partner'? Who is in charge; who is controlling whom?

"There were two significant NICE consultations during the year, on an End of Life Care Quality Standard and on the use of strong opioids. Our consultation responses were informed by extensive feedback from our working groups as well as by people with personal experience of end of life care,and many of our key recommendations were accepted."

(NCPC Report and Financial Statements 31 March 2012)

What 'independence' is there here? This is a complex coalition of diverse but not dissimilar organisations, in close discussion, consultation, all sharing a like interest of mutual benefit: the promotion of the Integrated/Gold Standards/DundeeDignity/Liverpool Care Pathways.

NCPC appear to have a finger dipped in every bowl, just for tasters, of course. The umbrella seems more and more like a web...

NCPC offers 'Corporate Partnerships', also.

One of these is Napp Pharmaceuticals -

The NCPC has a sister organisation, the SPPC -

Services in Scotland are provided by The Scottish Partnership for Palliative Care.
Click here to visit their website.

The web is as extensive in Scotland as it is south of the border, down Westminster way. Scottish Partnership for Palliative Care Director, Mark Hazelwood is quoted on the Scottish Government website here and the consensus statement, repeated mantra-like, of what the LCP is and is not is repeated here, above as it is below...

This is SPPC. Comments follow after –

Liverpool care pathway for the dying patient

Page Updated 21.12.12

Misconceptions and inaccurate information about the Liverpool Care Pathway risk detracting from the substantial benefits it can bring to people who are dying and to their families. They may also cause unfounded anxiety and distress.

The hospice movement in the UK is famous around the world for looking after dying people with dignity and skill. Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings, such as hospitals, care homes and people’s own homes.

The Liverpool Care Pathway:

• Requires staff ensure all decisions to either continue or to stop a treatment are taken in the best interest of each patient. It is not always easy to tell whether someone is very close to death – a decision to consider using the Liverpool Care Pathway should always be made by the most senior doctor available, with help from all the other staff involved in a person’s care. It should be countersigned as soon as possible by the doctor responsible for the person’s care.

• Emphasises that people should be involved in decisions about their care if possible and that carers and families should always be included in the decision-making process.

• Aims to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good.

• Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.

• Is continually evaluated in all the places where it is in use.

The Liverpool Care Pathway does not:

• Replace clinical judgement and is not a treatment, but a framework for good practice.

• Preclude the use of clinically assisted nutrition or hydration - it prompts clinicians to consider whether it is needed and is in the person’s best interest. GMC guidance (2010) provides specific information regarding this issue.

The Liverpool Care Pathway has been suggested as a model of good practice in the last hours and days of life by UK, English and Scottish national policy frameworks, including Living and Dying Well, the Scottish government’s national action plan for palliative and end of life care published in 2008. The General Medical Council published guidance on treatment and care towards the end of life in 2010 and the principles that underpin the Liverpool Care Pathway are consistent with that guidance.

The Liverpool Care Pathway is not in any way about ending life, but rather about supporting the delivery of excellent end of life care, to the benefit of patients and their families.

Statements of Support for the Use of the Liverpool Care Pathway

In the light of inaccurate and misleading media coverage about the Liverpool Care Pathway a number of organisations and individuals have made statements supporting the appropriate use of the pathway here

Other Resources

This is a link to an editorial on the Liverpool Care Pathway written by Kirsty Boyd and Scott Murray of Edinburgh University, published in the BMJ.http://bmj.com/cgi/content/full/bmj.e7718

Link to GMC guidance and supporting materials for doctors: http://www.gmc-uk.org/guidance/ethical_guidance/end_of_life_care.asp

Answers to some frequently asked questions on this topic - here

Comments: 4 (Add)

JACKIE LEOTARDI ON FEBRUARY 2 2013 AT 15:39

EUTHANASIA. There is no other word for the Liverpool Care Pathway. Starving and Dehydrating people to death, whilst sedating them on heavy doses of narcotics is murder. Just because hospital staff occasionally hand out a cheesy leaflet to relatives with a picture of clasped hands on the front doesn't make it any better. STOP abuse of the frailest and most vulnerable people in our society - the elderly. STOP the LCP

SLIEPNIR2006 ON FEBRUARY 2 2013 AT 13:09

Furthermore it is not misconception nor inaccurate to tell the truth, where as you are engaging in a deliberate act to deceive, misinform and mislead the public at every angle over the Liverpool Care Pathway!

SLIEPNIR2006 ON FEBRUARY 2 2013 AT 13:00

The BMA are playing the advocates to murder as regards the Liverpool Care Pathway. The implementation of this veritable viper, I say that because it does kill, has been done without, without care and the final decision, is based around decision making and guesswork

The facts are, that a number of people have faced the most appalling and painful deaths imaginable, they have been left without food, or water sometimes for days on end. I have even been told that when they were visiting the elderly relative, that they were giving the patient water when the doctors had withdrawn it! This is an absolute and veritable pack of lies!

The Liverpool Care Pathway is being used for murder, there is no doubt about that whatsoever. However saying that, there have also been cases where care has been properly implemented, however it can equally be said that where it has gone wrong, that without the framework in place, those patients would have still have been alive today!

There is no justification whatsoever to keep this in use and it is disgusting that it is. The BMA are the shame of the UK!

There is also the fact that people have not been told about their loved ones, there are many more who believe that their loved one's have been murdered and there is no reason to disbelieve them!

DON ON FEBRUARY 2 2013 AT 12:46

Why are you helping to cover up the huge number of manslaughters of non terminally ill to free up beds?

Liverpool Care Pathway - The Truth Is Unearthed

From a report by Mark Macaskill and Jon Ungoed-Thomas 2^nd April 2000 

Rita Pal, 28, a junior doctor, was so disturbed by her experiences that she is leaving the profession. This week she will submit a dossier to the General Medical Council (GMC) detailing the cases of abuse that she saw. 

"I have witnessed doctors who want to keep beds clear by withdrawing treatment or actively assisting in death to the point where it becomes involuntary euthanasia," she said. She wants the government to set up an independent inquiry.

She joined North Staffordshire hospital in 1998 and worked on two general medical wards - each with about 40 patients. In her first month, a senior doctor ordered the medication to be withdrawn from an 89-year-old stroke victim who was critically ill and could not speak because he had a plastic tube down his throat.

"This man was actually conscious and could hear us," said Pal. "The doctor said, 'We need the bed - stop all his medication'. He obviously didn't think he was going to live. I thought: we are killing someone because we want the beds. 

Please read further here -

A Continuing Risk - Liverpool Care Pathway: A National Scandal

13 Dec 2011

She joined North Staffordshire hospital in 1998 and worked on two general medical wards - each with about 40 patients. In her first month, a senior doctor ordered the medication to be withdrawn from an 89-year-old stroke ...

http://liverpool-care-pathway-a-national-sc.blogspot.com/

Not Anecdote Nor Chestnut Of - Liverpool Care Pathway: A National ...

29 Oct 2011

It follows similar critical reports of NHS failures at Mid-Staffordshire and Leeds Teaching Hospitals. There are calls for the second Mid-Staffordshire inquiry promised by the former health secretary, Andy Burnham, into the role ...

http://liverpool-care-pathway-a-national-sc.blogspot.com/

Please Petition Here - Liverpool Care Pathway: A National Scandal

19 Nov 2012

In reality, the medical establishment's culture has not changed as demonstrated by the Bristol, Shipman and Mid Staffordshire Inquiries. It is important that solutions are developed to effect a change in order to improve things ...

http://liverpool-care-pathway-a-national-sc.blogspot.com/

A Policy Of Insurmountable Folly - Liverpool Care Pathway: A ...

25 Aug 2011

In The Independent, it was reported that an inquiry into the Mid-Staffordshire NHS Foundation Trust reported last year that at least 400 patients may have died due to neglect and poor care. The chief NHS regulator has ...

http://liverpool-care-pathway-a-national-sc.blogspot.com/

Just A 'B in the Sky' Review? - Liverpool Care Pathway: A National ...

31 Dec 2012

Health Secretary Jeremy Hunt has admitted that there may still be 'pockets' of poor care like that revealed in Mid Staffordshire in 2008, where hundreds of patients died needlessly. Figures obtained by Panorama in a BBC ...

http://liverpool-care-pathway-a-national-sc.blogspot.com/

A Dangerous Legitimacy - Liverpool Care Pathway: A National ...

08 Jul 2012

Neither was allowed under hospital or professional regulations. Grigg-Booth, and at times other NNPs, also prescribed opiates such as pethidine and diamorphine for patients. This was risky and unlawful as they can hasten or ...

http://liverpool-care-pathway-a-national-sc.blogspot.com/

Dr. Rita Pal has bravely spoken up and spoken out about these problems, a voice in the wilderness. The sort of thing Dr. Pal witnessed in the North Staffs hospital is today granted legitimacy by the LCP. This is what the LCP is all about.

The EoLC Programme is all about grooming patients into accepting palliative in place of curative care options. This will save the NHS £billions and secure the NHS an "Affordable and Sustainable" future.

Only now, in 2013, has an inquiry which she long ago called for completed its ditherings. Why has it taken so long? And what more remains to be unearthed?

This is the NHS the Secretary of State wants to entrust with a killing machine, the LCP.

This is Mail Online -

Turn doctors and nurses into hospital inspectors to avoid more unnecessary deaths, says report into scandal-hit NHS trust

• Long-awaited public inquiry into the scandal-hit Mid Staffordshire NHS Trust to be published next week
• Up to 1,200 patients may have died needlessly
• Crackdown after such serious failings occurred despite various regulatory bodies being in place

By ANNA HODGEKISS

PUBLISHED: 10:43, 31 January 2013 | UPDATED: 16:06, 1 February 2013

Hospitals should be policed by an army of inspectors that include doctors and nurses to prevent major scandals and unnecessary deaths, a landmark report will warn next week.

The long-awaited public inquiry into the scandal-hit Mid Staffordshire NHS Foundation Trust is expected to recommend more experienced inspectors and an overhaul of the regulatory system.  

The report will recommend drastic reforms of how hospitals are policed in an attempt to stop a repeat of events at Stafford hospital where up to 1,200 patients may have died needlessly over a four-year period, reports The Guardian.

Up to 1,200 patients may have died needlessly over a four-year period at Stafford Hospital, where patients were found to have been treated 'appallingly'

The £11million inquiry, led by Robert Francis QC, is examining what went wrong at the trust between January 2005 and March 2009.

Between 400 and 1,200 more people died than would have been expected over that period, the Commission said.

Mr Francis' first report in 2010 found there was often 'shocking' care at Stafford hospital. 

Many patients were 'neglected', with calls for help to use the bathroom ignored, food and drink left out of patients' reach, pain relief administered late or not at all, 'awful' hygiene, and much more.

Some staff showed 'a disturbing lack of compassion', while 'fear and bullying' dissuaded others from flagging up their concerns. 

The long-awaited inquiry by Robert Francis QC (pictured) is expected to recommend a new army of hospital inspectors

Doctors were diverted from critically ill patients to deal with less serious cases that were at risk of breaching a central target to discharge all patients from Accident & Emergency units within four hours.  

Vulnerable patients were left so thirsty that they were forced to drink water out of flower vases; others were left starving and in soiled bedsheets.

Last month, the scandal-hit hospital paid out more than £1million in compensation for 'inhumane and degrading' treatment.

The new army of inspectors is thought to be in response to the fact that such serious failings occurred despite there being various regulatory bodies in place.

Huge questions remain over how such appalling standards of care continued for so long and why the relevant authorities did not intervene. 

Francis is expected to call for hospitals to undergo more regular and thorough inspections.  

A key move will be to get more experts with clinical experience, such as doctors and nurses, to join the 955 inspectors currently used by the Care Quality Commission (CQC) in NHS hospital visits.

Many of the current inspectors are thought to have a background in care homes and social work rather than the NHS.

In future, Monitor, which regulates NHS trusts, will be expected to share concerns about financial problems so the CQC can check if patient care is being affected.

And to tackle problems earlier, a recommendation will be made that the CQC's use of intelligence about hospital care is bolstered, using information from patient complaints, media reports and the results of clinical audits.

Liverpool Care Pathway - A Data Bonanza

The NHS Commissioning Board has authorised and established the first 34 clinical commissioning groups (CCGs).

From next April the NHS Commissioning Board will oversee the expenditure of the NHS budget and for 2013/14 the sum is £95.6 billion, with £64.7 billion being given to CCGs Clinical Commissioning Boards to commission healthcare for their local populations.

Commissioning End of Life Care

This document was jointly written by the National Council for Palliative Care and the National End of Life Care Programme -

The next two years provide a unique opportunity 
for new commissioning organisations to position 
themselves in the best clinical and financial position before they begin business as legal entities, for some at least as early as April 2013.

By targeting end of life care, emergent commissioners can place themselves in a strong position for one of the major required areas of improving quality and safety of care; improving patient and carer experience and making care more cost/resource efficient.

Tackling end of life care early can offer a number of significant ‘quick wins’ in improving the quality of care in your locality. People should be supported to be cared for and to die in their preferred place of care, which is usually their home (End of Life Care Strategy 2008). It may also include other community based settings such as a care home or sheltered housing. This means commissioners should ensure there is planned 24/7 provision of community support, including care co-ordination, nursing and symptom control.

End of life care accounts for a high proportion of NHS spending. The Demos think tank has estimated it as at least a fifth of NHS costs and a total of about £20 billion

There is considerable scope for improvement using interventions such as early identification triggers, advance care planning, co-ordination of care and effective multi disciplinary team (MDT) working.

They want to save £20 billion.

This is The National End of Life Care Intelligence Network -

The National End of Life Care Intelligence Network which is part of the The National End of Life Care Programme aims to improve the collection and analysis of information about end of life care services provided by the NHS, social services and the third sector. Areas of research include quality, volume and costs of care provided to adults approaching the end of life. This intelligence will help drive improvements in the quality and productivity of services.

"Quality and productivity" - an odd, cold, and clinical choice of words, used in systems management but not in the field of life and death medicine, surely.

These are 'unfortunate', inappropriate terminologies to use in the circumstance in which they are being used. Greater productivity in getting more 'end of lifers' onto the Pathway?

According to the Mail Online article which follows,

"Health Secretary Jeremy Hunt said he wanted millions of private medical records to be stored and shared between hospitals, GPs, care homes and even local councils. He sold the programme as part of plans for a ‘paperless NHS’ by 2018 and claimed ‘thousands of lives’ would be saved."

GPs are drawing up their 1% death lists of candidates for EoL care.

But local Councils...? Read this -

"A Good Death: the role of the local authority in end of life care" here -

Civil Society Innovation

Confidential health information is a gift to those earmarking likely candidates for palliative rather than curative care....

This is Mail Online -

Big brother to log your drinking habits and waist size as GPs are forced to hand over confidential records

• Data includes weight, cholesterol, BMI, family health history and pulse rate
• Doctors will be forced to reveal alcohol consumption and smoking status 
• Privacy campaigners described it as 'biggest data grab in NHS history'
• Part of new Health Service programme called Everyone Counts
• Officials insisted data will be anonymous and deleted after analysis

By JACK DOYLE

PUBLISHED: 22:28, 1 February 2013 | UPDATED: 08:54, 2 February 2013

GPs are to be forced to hand over confidential records on all their patients’ drinking habits, waist sizes and illnesses.

The files will be stored in a giant information bank that privacy campaigners say represents the  ‘biggest data grab in NHS history’.

They warned the move would end patient confidentiality and hand personal information to third parties.

Data grab: Doctors will be forced to hand over sensitive information about patients as part 

of a new programme called Everyone Counts but campaigners have criticised the move

The data includes weight, cholesterol levels, body mass index, pulse rate, family health history, alcohol consumption and smoking status.

Diagnosis of everything from cancer to heart disease to mental illness would be covered. Family doctors will have to pass on dates of birth, postcodes and NHS numbers.

Officials insisted the personal information would be made anonymous and deleted after analysis.

But Ross Anderson, professor of security engineering at Cambridge University, said: ‘Under these proposals, medical confidentiality is, in effect, dead and there is currently nobody standing in the way.’ Nick Pickles, of the privacy group Big Brother Watch, said NHS managers would now be in charge of our most confidential information.

He added: ‘It is unbelievable how little the public is being told about what is going on, while GPs are being strong-armed into handing over details about their patients and to not make a fuss.

‘Not only have the public not been told what is going on, none of us has been asked to give our permission for this to happen.’

The data grab is part of Everyone Counts, a programme to extend the availability of patient data across the Health Service.

Campaigners for privacy: They warn the move would end patient confidentiality and 

hand personal information to third parties

GPs will be required to send monthly updates on their patients to a central database run by the NHS’s Health and Social Care Information Centre.

Health chiefs will be able to demand information on every patient, such as why they have been referred to a consultant. Another arm of the NHS will supply data on patient prescriptions.

In a briefing for GPs, health chiefs admit that ‘patient identifiable components’ will be demanded, including post code and date of birth.

NHS officials insist the information centre will be a ‘safe haven’ for personal data, which will be deleted soon after it is received.

The information will be used to analyse demand for services and improve treatment.

But a document outlining the scheme even raises the prospect of clinical data being passed on or sold to third parties.

It states: ‘The patient identifiable components will not be released outside the safe haven except as permitted by the Data Protection Act.

‘HSCIC ... will store the data and link it only where approved and necessary, ensuring that patient confidentiality is protected.’

Patients will not be able to opt out of the system.

Before the election the Tories condemned the creation of huge databases – including the controversial NHS IT project – and insisted it would roll back ‘Labour’s database state’.

But last month, in the first sign of a dramatic shift away from this position, Health Secretary Jeremy Hunt said he wanted millions of private medical records to be stored and shared between hospitals, GPs, care homes and even local councils. He sold the programme as part of plans for a ‘paperless NHS’ by 2018 and claimed ‘thousands of lives’ would be saved.

But details of the changes have raised serious concerns among civil liberties and privacy campaigners, as well as health professionals

Last night GPs’ leaders said the latest proposals were too broad.

‘Patients must be given the option to opt out of any scheme that seeks to transfer identifiable information about them from their records to another source,’ said a BMA spokesman.

‘This opt-out should be widely advertised and explained in order that patients are reassured and understand the process being carried out.’

Phil Booth of the campaign group NO2ID said an unprecedented volume of data would be ‘sucked up’.

‘People have to trust in the notion of medical confidentiality. They expect to be able to talk in confidence to their GP,’ he said.

‘They don’t expect their private conversations to be uploaded on to a national database where they will be made available for any number of purposes for the benefit of persons unknown.’

A spokesman for the NHS said last night: ‘The NHS constitution makes clear what information can be used for by the NHS and this proposal complies exactly with that.’

Liverpool Care Pathway - "Sneaky And Underhand"

This is The Scotsman -

Plan for end of life care branded ‘underhand’

Jean Tulloch s son claims to have visited her in hospital to find her 

intravenous drip had been removed

Published on Thursday 31 January 2013 12:00

LOTHIAN health bosses have been branded “sneaky” and “underhand” after it emerged that they had discussed “rebranding” controversial guidance for providing end of life care.

Use of the Liverpool Care Pathway, which sets out guidelines designed to ensure people are comfortable in their final hours, can see nutrition withdrawn from dying patients and has attracted negative publicity following fears it is adopted as a way of bringing in “euthanasia by the back door”.

And with the Liverpool Care Pathway protocol being rolled out across NHS Lothian, it has emerged that influential health chiefs have mooted changing its name to the Lothian Care Pathway when it is used here.

Morag Bryce, a member of the NHS Lothian board and the chair of its Healthcare Governance Committee, admitted those close to patients had become concerned about the pathway. Ms Bryce said: “There has been significant media coverage which has worried families and carers.”

The possible name change was discussed at last month’s Healthcare Governance Committee, but NHS Lothian said today that it currently has no plans to rebrand the pathway.

Dr Jean Turner, a former anaesthetist and director of the Scotland Patients Association, said she believed it made the health board appear “sneaky”.

“They are underestimating the intelligence of the public,” she said. “The Liverpool Care Pathway is excellent when used appropriately – I noticed to my horror that people think it’s a form of euthanasia. But the answer is to make people understand what it is.

“Changing the name would be a bit underhand. This will just make people think the NHS really are trying to bump people off.”

Peter Tulloch, whose 83-year-old mother Jean was admitted to the Western 
General Hospital with a urinary tract infection, alleges that on one visit he found her intravenous drip had been removed.

After he raised concerns in March last year she was taken off the Liverpool Care Pathway, but died two weeks later.

In the six months to the end of August last year, the Liverpool Care Pathway was adopted for 616 patients in Lothian hospitals and in a 12-month period, it was implemented for 293 other patients in the community. Of the hospital patients, 28 were later taken off the pathway, while seven survived.

NHS Lothian is set to launch an information campaign, while its leaflet, called What Happens When Someone is Dying? is being reviewed.

Dr David Farquharson, NHS Lothian’s medical director, said: “We are aware of the importance of communicating with and supporting people whose relatives are in the last days and hours of life.

“Discussions with a patient’s family are vital and it’s important to ensure they are included in the decision-making and care plan and that they understand that it is being considered so that their loved one can be given excellent end of life care.

“The decision to consider end of life care is always taken by a senior clinician and the medical staff involved in the patient’s care. This information is recorded within the Liverpool Care Pathway document.

“We strive to continually improve the quality of end of life care and as part of this we are reviewing the current information leaflet. This involves carer groups to ensure the information provided meets the needs of families and carers.”

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 -

QNIS REPORT EJDCl01 DR BRIDGET JOHNSTON

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 -

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

The Patient Dignity Inventory: applications in the oncology setting.

Chochinov HM, McClement SE, Hack TF, McKeen NA, Rach AM, Gagnon P, Sinclair S, Taylor-Brown J.

Source

Department of Psychiatry, Manitoba Palliative Care Research Unit, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada. harvey.chochinov@cancercare.mb.ca

Abstract

BACKGROUND:

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.

PURPOSE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:

 

22946576

 

[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?

Psychometrics:

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.