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This chapter discusses care pathways, which are also known as critical pathways, clinical pathways, and integrated care pathways, and are used for a variety of patient groups worldwide. The chapter discusses the history and working definition of care pathways, and looks at care pathways as a concept, a model, a process, and a product. The last section in this chapter focuses on a discussion and the challenges for palliative care, such as developing and implementing pathways that have the patient focused care paradigm as the main driver.

This chapter discusses Integrated Care Pathways and their development, role, and integration into modern day health care. Integrated Care Pathways determine locally agreed, multidisciplinary practice that is based on guidelines and evidence where available, for a specific patient or user group. The chapter identifies the origins of Integrated Care Pathways, their place in the modern health care system, and the possible reasons for using them. The key stages of the pathways and the potential for palliative care and pathways are discussed in the latter portion of the chapter.

This chapter discusses the integrated care pathway (ICP), which is an outline of the care required for a specific procedure or disease providing structured integrated documentation and consistent records. Successful ICP implementation requires both vision and organizational commitment from senior managers and staff in all departments and disciplines. Good clinical leadership for individual pathways, as well as a feeling of ownership by the staff using the pathways, is the key to success. Each pathway must have a team dedicated to its development and facilitation and there must be continual education and information dissemination, usually using workshops and training programmes, to keep up with constantly changing staff. Successfully designed and implemented ICPs improve the quality and safety of patient care.

This chapter discusses how to use the Liverpool Care Pathway for the Dying Patient (LCP). It determines how and why the LCP was developed. The LCP's variances and components are also discussed. The chapter provides a hospital version of the LCP, which shows the forms for the initial assessment, ongoing assessment, and the verification of death.

This chapter discusses the analysis and feedback of the data recorded. This is an important aspect of the implementation of the Liverpool Care Pathway for the Dying Patient (LCP). Other ways to analyse and collect the data are studied, and the authors determine whether the LCP can be used for patients without cancer. The chapter also asks whether integrated care pathways can be developed for other aspects of palliative care, and studies the role of the LCP in research and development. Future developments in the LCP and its use in teaching and education are also discussed.

This chapter discusses in detail the Liverpool Care Pathway for the Dying Patient (LCP), which was briefly discussed in the introductory chapter. It looks at the LCP Continuous Quality Improvement Programme, which is one of the key programmes found within the Marie Curie Palliative Care Institute Liverpool (MCPCIL) portfolio. It discusses the format and outline of the LCP and introduces the concepts of variance reporting, which tells the ‘story’ of the patient's journey and current condition, and organizational governance. It then moves on to the innovation and change model, the recognition and diagnosis of dying, and the MDT assessment. The latter half of the chapter focuses on the different steps taken in order to complete the LCP.

This chapter provides an overview of the care of the dying within the framework of the Liverpool Care of the Dying Pathway (LCP) and then looks specifically at the care of the patient who is dying of heart failure (HF). There are generally four phases of care identifiable within the dying trajectory: diagnosing dying; initial assessment and care; ongoing care; and care after death. These four phases are particularly discussed. This document replaces all other documentation for the multidisciplinary team, and becomes the focus for the patient's management. It has attached symptom control guidelines and associated information leaflets to support health-care professionals and relatives. The skills required to care for a patient dying from HF are similar to those required to care for a patient dying from cancer. Many centres using the LCP routinely use it unchanged for patients dying with HF. However, there are several specific issues in relation to HF that can make both recognition and management of the dying potentially difficult.

This chapter discusses symptom control in care of the dying. It begins by discussing how the Liverpool Care Pathway for the Dying Patient (LCP) can influence symptom control, and then determines the commonest symptoms in a dying patient. The chapter looks at managing various ailments of a dying patient, including pain, agitation, and nausea and vomiting. It then determines the different factors doctors need to consider when taking care of a dying patient, such as the application of drugs, providing comfort in the last hours or days of a patient's life, and even management of skin.

This chapter provides an introduction to the concept of care pathways and defines such pathways in the context of palliative and end-of-life care. An overview of existing care pathways in palliative care is given, including both those which focus on the dying phase and those which are intended to provide care over a longer trajectory. Issues relating to the development of care pathways for older people are examined, and care pathways which address the specific needs of older people with dementia are considered. An analysis of the evidence base is provided, and recommendations are made for future development and implementation of care pathways for older people and their families at the end of life.

After discussing the value of experimentally scrutinizing patients’ compliance to treatment regimes, this chapter turns to the study of clinicians’ compliance to standards. Following a similar rhetorical structure as the compliance debate on the actions of patients, the low adherence rates of healthcare professionals to clinical guidelines is often seen as highly problematic by health scientists and policy makers. However, as in the debate on patient adherence, the common ‘solutions’ to improve the success rate of implementation initiatives tend to leave the epistemological status of aggregated medical knowledge untouched. Such initiatives are caught up in a dichotomy of universal clinical knowledge and particular patient characteristics, which is not a productive rendering of the problems encountered in clinical practice. To explore a different notion of standardization, this chapter explores the experimental interventions in a healthcare improvement project at a hematology/oncology outpatient clinic. This project articulates the value of situated standardization for both clinical practice and for the integrated pathway movement, rather than following the above-mentioned extremes of striving for full rationalization of medical practice, or of celebrating complexity that boycotts standardization.

This chapter deals with possibilities for sociology in enacting emerging healthcare markets. Drawing on research on the development of situated standardization through process redesign in a national healthcare quality collaborative, it analyzes the possibilities for enacting healthcare markets as value- rather than cost-saving driven. Though this project was initially largely successful, sociological interventions in the construction of markets may prove more risky than some scholars in Social Studies of Markets suggest. These markets turned out to ‘work’ quite well despite the poor quality of the market devices that were to frame it as value-driven. Later on, when the quality of these devices improved, the market actually focused more on cost saving. Since many scholars who entered Social Studies of Markets from Actor-network theory, they have argued for the importance of market devices in framing values. This chapter shows the importance of sensitizing the sociological interventions to prevailing market regimes and market practices as ‘forms of the probable’ that are highly consequential for the acting space of social scientists in performing markets.

This chapter provides a means of looking at a health condition or health issue through the lens of identifying effective preventive opportunities. The concept of an effective preventive opportunity is firstly clarified for use. A ‘spectrum of preventive opportunities’ model is then described which can be used to identify these opportunities for any health condition. In this model, effective opportunities are considered across a whole generic care-pathway chronology, which also acts as a prompt to considering the potential range of health service responses and to help think about the natural development of the health condition or issue. Examples illustrate that the principles can be applied to single conditions, groups of conditions, and system issues. There is also a ‘population health sieve’ summary of the different risk factor types in a population, and a summary of the different types of health service response.

Dying is a normal part of living and some would suggest the most important. The major challenge for the dying is to accept what is and what will be, but acceptance is not easy. People die alone and unaccompanied but we may be with them to the very threshold. The ‘Liverpool Care Pathway for the Dying’ promotes comfort and well-being for patient and family at the end of a life. For the patient there can be wistfulness about the past and a questioning about the future. Rituals, letters or memory boxes can help, but it is argued that their impact on the dying patient and on the survivors needs to be carefully explored. For the bereaved it is also a hard time. Some common attitudes towards and by the bereaved are reviewed and commented upon, as is the value of bereavement support. Adjustment to the loss can take months, years or is never achieved. Grief is a painful experience, but it need not necessarily be destructive.

Health protection is a core technical competency in public health and for its practitioners. It is a term used to encompass activities that ensure robust health security at local, national, and global levels. Its activities aim to protect the public from avoidable health risks and minimize the health impacts of these risks. These may include the strengthening of capacity in climate change and sustainability, emergency preparedness, communicable disease control, and environmental and planetary health. This chapter describes the key basic public health concepts, principles, and approaches and provides an overview of health protection: health, public health, health protection, health improvement, health services and management, determinants of health, indicators for the burden of disease, epidemiology and demography, disease burden, development and health risk transition, life-course approach, pathway of care, hierarchy of prevention, health promotion, health system, and levels of care.

Thoracic oncology

Types of lung cancer

Small cell (15%).

Non-small cell (85%):

Adenocarcinoma (35–40% of total).

Squamous cell (25–30%).

Large cell (10–15%).

Bronchoalveolar cell carcinoma (2–3%).

Carcinoid (1%).

Paraneoplastic syndromes

Small cell:

Syndrome of inappropriate antidiuretic hormone secretion (SIADH), ectopic adrenocorticotropic hormone (ACTH) (Cushing’s...