The Effectiveness of the LCP in Improving End of Life Care for Dying Cancer Patients in Hospital.

• Quality of end-of-life care provided to dying cancer patients and their families. [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Measured through the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
  
  

• quality of communication between the healthcare professionals, patients and families [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
  
  
• quality of emotional support to family members before and after the patients' death [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
  
  
• coordination of care [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
  
  
• provision of care focusing on patient's individual needs [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
  
  
• patient's physical well-being through a better control of physical symptoms [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Symptom scales (pain, breathlessness and vomiting) from the Italian version of VOICES (Costantini M, 2005)
  
  
• quality of communication between hospital staff and GPs [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  interview with GPs
  
  
• appropriateness of therapeutic and diagnostic procedures [ Time Frame: six months after the implementation of the LCP Program ] [ Designated as safety issue: No ]
  Tool for recording all diagnostic and therapeutic procedures effectively performed during the last 3 days of life
  
  

The availability of an effective quality improvement program for the care of dying patients in hospitals is particularly relevant to the healthcare scenario. The LCP-I Program has provided enough evidence to justify a randomized trial to evaluate its effectiveness.

Although the core objective of the LCP-I is improving the quality of end of life care for dying patients, the Program targets the healthcare professionals working on the hospital ward. The only feasible method of assessing the effectiveness of this Program is by performing a cluster trial, where hospital wards are randomized to receive (or not to receive) the implementation of the LCP-I Program.

Pairs of eligible medical wards from different hospitals will be randomized to receive the experimental intervention (the LCP-I Program) or no intervention at all for the duration of the study.

The LCP-I Program will be implemented in the experimental ward by the PCU. The LCP-I Program has a duration of 6 months from the beginning of the intensive training. No intervention will be implemented in the control ward until the end of the evaluation.

Quality of end-of-life care will be evaluated for each pair of randomized wards for all eligible cancer deaths occurring in the six months after the conclusion of the LCP-I Program in the experimental ward.