Table 4 Summary of the 2 original studies investigating the effect/further development of Liverpool Care Pathway (LCP) in AGW = Acute Geriatric Ward; GGW = General Geriatric Ward; GSFCH = Gold Standards Framework for Care Homes; PCU = Palliative Care Unit

Ekestrom ML, 2014, Sweden [26]

Non-controlled, before - after implementation of the LCP in a PCU and in a GGW. 44 family members of diseased patients from GGW participated (21 before and 23 after LCP implementation)

Explore family members’ experiences of end-of-life care

Questionnaire 3–6 months after death Comparisons between the samples by non-parametric tests

Physicians’ ability to listen to family members’ concerns suggested increasing. Very small numbers in sub-groups and not-randomized study design make interpretability of results questionable.

Grading: 2b

Verhofstede R, 2015 [16], Belgium

Phase 0–1 methodology study based on Medical Research Council framework to develop and evaluate a complex intervention Phase 0 consists of a review of existing LCP programs from UK, Italy, and the Netherlands (NL), to identify factors for a successful LCP implementation and analysis of the concerns raised in the UK.

Phase 1, is the development a care program for last days of life for older patients dying in AGW based on phase 0.

Develop a new care program to improve care in the last days of life for older patients dying in AGW

- Review of LCP-programs developed in UK and used in Italy and Netherland

- Development of a care program

Pre-clinical phase: Non-systematic review identified three common documents: LCP documents, supportive documents, implementation guide.

Modelling phase: Development of Care Guide for last days of life: supportive documentation, implementation guide for older hospital population. Dementia or ACP are not mentioned as an outstanding challenge in evaluation and treatment of pain and symptoms or communication

Grading: 2b