Liverpool Care Pathway for patients with cancer in hospital: a cluster randomised trial.

BACKGROUND: The quality of care provided to patients with cancer who are dying in hospital and their families is suboptimum. The UK Liverpool Care Pathway (LCP) for patients who are dying was developed with the aim of transferring the best practice of hospices to hospitals. We therefore assessed the effectiveness of LCP in the Italian context (LCP-I) in improving the quality of end-of-life care for patients with cancer in hospitals and for their family. METHODS: In this pragmatic cluster randomised trial, 16 Italian general medicine hospital wards were randomly assigned to implement the LCP-I programme or standard health-care practice. For each ward, we identified all patients who died from cancer in the 3 months before randomisation (preintervention) and in the 6 months after the completion of the LCP-I training programme. The primary endpoint was the overall quality of care toolkit scale. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01081899. FINDINGS: During the postintervention assessment, data were gathered for 308 patients who died from cancer (147 in LCP-I programme wards and 161 in control wards). 232 (75%) of 308 family members were interviewed, 119 (81%) of 147 with relatives cared for in the LCP-I wards (mean cluster size 14·9 [range eight to 22]) and 113 (70%) of 161 in the control wards (14·1 [eight to 22]). After implementation of the LCP-I programme, no significant difference was noted in the distribution of the overall quality of care toolkit scores between the wards in which the LCP-I programme was implemented and the control wards (score 70·5 of 100 vs 63·0 of 100; cluster-adjusted mean difference 7·6 [95% CI -3·6 to 18·7]; p=0·186). INTERPRETATION: The effect of the LCP-I programme in our study is less than the effects noted in earlier phase 2 trials. However, if the programme is implemented well it has the potential to reduce the gap in quality of care between hospices and hospitals. Further research is needed to ascertain what components of the LCP-I programme might be effective and to develop and assess a wider range of approaches to quality improvement in hospital care for people at the end of their lives and for their families. FUNDING: Italian Ministry of Health and Maruzza Lefebvre D'Ovidio Foundation-Onlus.

Implementation of the Liverpool Care Pathway (LCP) for the dying patient in the inpatient hospice setting: development and preliminary assessment of the Italian LCP program.

BACKGROUND: The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. AIM: Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. METHODS: This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. RESULTS: The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. CONCLUSIONS: The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.

The role of the clinical trial nurse in Italy.

PURPOSE: To assess the role of the Clinical Trials Nurse (CTN) and to evaluate the quality of the job performed by Clinical Trials Nurses (CTNs) in Italy. METHODS: The study design was descriptive. The sample included 30 CTNs in Italy who were involved in conducting clinical trials in the last years. Respondents completed the Italian Clinical Trials Nursing Questionnaire (CTNQ) developed to measure frequency and importance of clinical trials nursing activities. Data analyses included descriptive statistics, Student's t-test and Chi-Square test. RESULTS: Thirty out of 34 CTNs consented to participate. Respondents were more involved in the experimental drug management, in the protocol implementation and, partially, in the informed consent process. CTNs have a marginal position with respect to the protocol assessment and planning, subject recruitment, data management. CTNs reported high rates for the importance evaluation. Number of years in the nursing role was significantly associated with data management related activities (p = 0.016). Items with minor response rate differences between frequency and importance were not statistically significant (p values ranging from 0.087 to 0.911). The CTNs reported to be autonomous and competent; however, they lack and/or do not perform some nursing-related responsibilities and/or activities. CONCLUSIONS: Although CTNs are not involved in all of the activities listed on the CTNQ, most of them are fully aware to be a key member of research teams. Overall, the Italian CTN role is mostly practical task-oriented and focuses little on data management and organizational activities.

Aportes para pessar desde una perspectiva bioétca la percepción ciudadana de lla ciencia y la tecnología en la provincia de córdoba (república Argentina) / Contriutions to ponder on, from a bioethical perspective to the citizen understanding of science and technology in the province of córdoba (argentine republic) / Contriuições parra penar a partir de uma perspectiva bioética para a percepção cidadã da ciência e da tecnologia na província de córdoba (república Argentina)

Para orientar los procesos de decisiones en la esfera pública, resulta pertinente conocer la percepción de los ciudadanos respecto de la ciencia y la tecnología. Partimos del reconocimiento de la importancia del desarrollo y apropiación del conocimiento científico y tecnológico, enmarcados en perspectivas bioéticas e influenciados por ellas. La propuesta se contextualiza en acciones en desarrollo en Argentina para el fomento de la ciencia y la tecnología, a través del proyecto Percepción y participación ciudadana para una cultura científica-tecnológica en la provincia de Córdoba, Argentina, que incluye aspectos asociados a valoraciones, creencias y prejuicios sociales y culturales, entretejidas con lo ético. Se aportan reflexiones en torno a los aspectos bioéticos y se espera que el producto de la investigación y sus derivados sean aportes a la comunidad e insumos para el diseño de un modelo de participación ciudadana que fomente el uso de los resultados de la investigación en beneficio de la humanidad.

In order to guide the processes of decision-making in the public arena, it is relevant to know about the citizens' understanding of science and technology. We start by acknowledging the importance of the development and the ability to appropriate the scientific and technological knowledge framed within the bioethical perspectives and influenced by them. The proposal is contextualized within the ongoing actions in Argentina to foster science and technology by means of the project "Citizen understanding and participation with the aim of a scientific-technological culture in the province of Córdoba, Argentina", which includes aspects related to values, social and cultural beliefs and prejudices interwoven by an ethical thread. Thoughts are given in relation to bioethical aspects. We hope that the product of this research work and its derivatives become a contribution and an input for the design of a model of citizen participation that fosters the use of this research work supporting mankind.

Para orientar os processos de tomada de decisão na esfera pública, é relevante conhecer a percepção dos cidadãos sobre a ciência e a tecnologia. Começamos a partir do reconhecimento da importância do desenvolvimento e assimilação do conhecimento científico e tecnológico, enquadrados em perspectivas bioéticas e influenciados por essas. A proposta é contextualizada em ações em desenvolvimento na Argentina para a promoção da ciência e da tecnologia, através do projeto Percepção e participação cidadã para uma cultura científico - tecnológica, na província de Córdoba, Argentina, que inclui aspectos relacionados com as valorizações, crenças e preconceitos sociais e culturais, entrelaçados com a ética. Aportam-se reflexões sobre os aspectos bioéticos e é esperado que o produto da investigação e seus derivados fossem contribuições para a comunidade e matéria-prima para a concepção de um modelo de participação cidadã para promover a utilização dos resultados da investigação em benefício da humanidade.