![]() ![]() There was concern that impaired patient consciousness may lead to an earlier death, and that effects of opioids on appetite and thirst may result in unnecessary suffering. The impact of opioids was a particular concern because of their potential influence on consciousness, appetite and thirst in people near the end of life. In July 2013, the Department of Health released a statement that stated the use of the LCP should be "phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient". It also found that the LCP often was not implemented properly, and had instead become a barrier to good care it made over 40 recommendations, including education and training, research and development, access to specialist palliative care services, and the need to ensure care and compassion for all dying patients. The resulting Neuberger Review acknowledged that the LCP was based on the sound ethical principles that provide the basis of good quality care for patients and families when implemented properly. In England the LCP was the subject of an independent review, commissioned by a Health Minister. The use of the Liverpool Care Pathway (LCP) in the UK has been criticised. In the last ten years the use of care pathways to aid those treating patients at the end of life has become common worldwide. There is increasing focus on providing high quality care for people at the end of life, irrespective of disease or cause, and in all settings. These results may contribute to understanding the effects of opioids on consciousness, appetite, and thirst in end-of-life care in all patients deemed to be people who are dying. ![]() Weakness, diarrhoea, insomnia (difficulty in sleeping), mood change, hallucinations and dehydration occurred at rates of 1 in 20 people and below. Known problems with adverse event measurement, recording, and reporting made assessment even more difficult.įor all four opioids together, 1 in 4 people experienced constipation and somnolence (sleepiness, drowsiness), 1 in 5 experienced nausea and dry mouth, and 1 in 8 experienced vomiting, loss of appetite, and dizziness. Trial quality was generally poor particular problems included small study size, and not reporting adverse events in all patients, or all recorded adverse events. The population in these trials was mainly aged between 50 and 70 years. This review identified 77 studies with over 5,000 people who received various treatments. Information these trials provide is likely to be the closest that is available to opioid use in end-of-life care - although people treated for cancer pain are not usually at the end of their lives. So, we looked at trials of people being treated with opioids for cancer pain, as the Ideally, when writing this review we would have looked at medical trials of opioid use in older people receiving end-of-life care, but there are no trials in this area. This Cochrane review was commissioned to look at harms (adverse events) associated with the use of opioids to treat cancer pain particularly relating to patient consciousness, appetite or thirst. A government review of the use of end-of-life care pathways in the NHS in the UK recommended they should not be used because they were being misused.Ī concern, mainly raised by relatives, was that opioids were over-prescribed, used to hasten death, to reduce consciousness, and diminish the patient's desire or ability to accept food or drink. The Liverpool Care Pathway was devised for use in hospices, and has been used in general hospital settings to care for dying patients. ![]() Care pathways have been used to ensure appropriate care for people who are dying in hospice settings. Such pathways are commonly used, and often produce good results, but they can also be used as a tick box solution that acts as a barrier to good care. Care pathways are packages of care designed to ensure that patients have appropriate and effective care in particular situations. ![]()
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