Table 3.

Summary of the 2 original studies investigating the effect of using the GSFCH = Gold Standards Framework for Care Homes and Liverpool Care Pathway (LCP) in nursing homes (NH). DNAR = Do Not Attempt Resuscitation

1st author, year, nationality	Design/participants	Study objective	Outcome measures	Results
Hockely J, 2010, UK [24]	Qualitative interviews of bereaved relatives, pre−/post-implementation of the GSFCH and LCP in 7 Scotch NHs. Notes of 228 patients who had died prior to and during the project were examined, alongside a staff audit looking at the effect of GSFCH and LCP.	Investigate the implementation strategy of high facilitation including NH visits every 10–14 days and in-house staff training over 18-month.	In-depth evaluation of professional practices and residents outcomes	High staff turn-over (>33%). Use of LCP rose from 3% to 30%. Three of 7 NHs used it regularly. General increase of DNAR and ACP and reduction of hospital admissions/deaths. Pain, symptoms, medication use not reported. Isolated LCP effect unclear.
Grading: 2b
Watson J, 2010 [25], UK	Qualitative interviews with 22 bereaved relatives/friends before (08/06–01/07) and 14 bereaved relatives/friends and six care home managers after (01/08–04/08) implementation of the GSFCH and LCP into 7 Scotch NHs.	Evaluate the impact on the quality of end-of-life care of the GSFCH and LCP. Implementation reported elsewhere (Hockely et al. 2010)	Content analyses of the 7Cs of the GSFCH related to GSFCH implementation	“Some NHs were using the LCP”. One relative comments that instructions were followed academic such as a textbook. Meanwhile all patients are individually. Another relative recognized that the patient was “changed every single day”. Unclear how many people were treated with LCP of NHs which used the LCP.
Grading: 4