Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study

Kesten, Joanna M; Redwood, Sabi; Pullyblank, Anne; Tavaré, Alison; Pocock, Lucy; Brant, Heather; Hill, Liz; Tutaev, Mary; Shum, Rui Zhi; Banks, Jonathan

doi:10.1093/ageing/afac226

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Indeed, an interview study of GPs and care home staff found that GPs value the input of care home staff in ReSPECT conversations. (18) Whilst care home staff were generally positive about being involved, they had concerns about taking responsibility for the form's content. (18).…”

Section: Discussionmentioning

confidence: 99%

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GPs’ views on emergency care treatment plans: an online survey

Underwood,

Noufaily,

Blanchard

et al. 2024

BJGP Open

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BackgroundA holistic approach to emergency care treatment planning is needed to ensure that patients’ preferences are considered should their clinical condition deteriorate. To address this Emergency Care and Treatment Plans (ECTPs) have been introduced. Little is known about their use in general practice.AimTo survey general practitioners’ (GPs’) experiences of, and views on, using ECTPs.Design & settingOn-line survey of GPs practising in England.MethodA survey of 841 GPs using the monthly on-line survey provided by Medeconnect, a market research company.ResultsECTP forms were used by 49% of respondents’ practices (84% of these were Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans); 51% used do not attempt cardio-pulmonary resuscitation (DNACPR) forms. GPs are the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community-based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of respondents’ practices.When compared to using a DNACPR form GPs using a ReSPECT form for emergency care treatment planning were more comfortable having these conversations with patients (OR =1.72, 95% CI 1.1–2.69) and family members (OR =1.85 (95% CI 1.19–2.87).ConclusionThe potential benefits and challenges of widening the pool of health and social care professionals initiating and / or completing the ECTP process needs consideration. ReSPECT plans appears to make GPs more comfortable with ECTP discussions supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened.

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Section: Discussionmentioning

confidence: 99%

“…(18) Whilst care home staff were generally positive about being involved, they had concerns about taking responsibility for the form's content. (18).…”

Section: Discussionmentioning

confidence: 99%

GPs’ views on emergency care treatment plans: an online survey

Underwood,

Noufaily,

Blanchard

et al. 2024

BJGP Open

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“…Despite the centrality of patients and relatives to the ReSPECT process, no study so far has investigated patients’ and relatives’ experiences of ReSPECT in the community. In addition to our earlier programme of work, we have identified only one other qualitative study on the ReSPECT process; this study examined how general practitioners (GPs) and social care staff experienced ReSPECT in the care home context [ 9 ]. Moreover, a recent qualitative systematic review found only one study that focused on patient experiences of CPR-related conversations in the UK, predating the ReSPECT process [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Patient and relative experiences of the ReSPECT process in the community: an interview-based study

Eli,

Harlock,

Huxley

et al. 2024

BMC Prim. Care

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Background The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was launched in the UK in 2016. ReSPECT is designed to facilitate meaningful discussions between healthcare professionals, patients, and their relatives about preferences for treatment in future emergencies; however, no study has investigated patients’ and relatives’ experiences of ReSPECT in the community. Objectives To explore how patients and relatives in community settings experience the ReSPECT process and engage with the completed form. Methods Patients who had a ReSPECT form were identified through general practice surgeries in three areas in England; either patients or their relatives (where patients lacked capacity) were recruited. Semi-structured interviews were conducted, focusing on the participants’ understandings and experiences of the ReSPECT process and form. Data were analysed using inductive thematic analysis. Results Thirteen interviews took place (six with patients, four with relatives, three with patient and relative pairs). Four themes were developed: (1) ReSPECT records a patient’s wishes, but is entangled in wider relationships; (2) healthcare professionals’ framings of ReSPECT influence patients’ and relatives’ experiences; (3) patients and relatives perceive ReSPECT as a do-not-resuscitate or end-of-life form; (4) patients’ and relatives’ relationships with the ReSPECT form as a material object vary widely. Patients valued the opportunity to express their wishes and conceptualised ReSPECT as a process of caring for themselves and for their family members’ emotional wellbeing. Participants who described their ReSPECT experiences positively said healthcare professionals clearly explained the ReSPECT process and form, allocated sufficient time for an open discussion of patients’ preferences, and provided empathetic explanations of treatment recommendations. In cases where participants said healthcare professionals did not provide clear explanations or did not engage them in a conversation, experiences ranged from confusion about the form and how it would be used to lingering feelings of worry, upset, or being burdened with responsibility. Conclusions When ReSPECT conversations involved an open discussion of patients’ preferences, clear information about the ReSPECT process, and empathetic explanations of treatment recommendations, working with a healthcare professional to co-develop a record of treatment preferences and recommendations could be an empowering experience, providing patients and relatives with peace of mind.

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“…Treatment escalation planning involves prospective decision-making regarding the range of increasingly intensive or complex interventions offered during an admission. Advance care planning (ACP) promotes shared decision-making, enabling patients to make informed choices about their future healthcare, including treatment escalation and end of life care [ 7 , 8 ]. However, ACP is poorly implemented in frailty with patients rarely given the chance to express their preferences [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, ACP is poorly implemented in frailty with patients rarely given the chance to express their preferences [ 9 , 10 ]. Emergency care and treatment plans, which summarise patient goals of care for emergency situations, have emerged to support acute decision-making but concerns about their use in practice include a tendency to focus solely on resuscitation decisions or end of life planning [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“I’d rather wait and see what’s around the corner”: A multi-perspective qualitative study of treatment escalation planning in frailty

Lound,

Bruton,

Jones

et al. 2023

PLoS ONE

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Introduction People living with frailty risk adverse outcomes following even minor illnesses. Admission to hospital or the intensive care unit is associated with potentially burdensome interventions and poor outcomes. Decision-making during an emergency is fraught with complexity and potential for conflict between patients, carers and clinicians. Advance care planning is a process of shared decision-making which aims to ensure patients are treated in line with their wishes. However, planning for future care is challenging and those living with frailty are rarely given the opportunity to discuss their preferences. The aim of the ProsPECT (Prospective Planning for Escalation of Care and Treatment) study was to explore perspectives on planning for treatment escalation in the context of frailty. We spoke to people living with frailty, their carers and clinicians across primary and secondary care. Methods In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops. Results We spoke to 44 participants (9 patients, 11 carers and 24 clinicians). Four main themes were identified: frailty is absent from treatment escalation discussions, planning for an uncertain future, escalation in an acute crisis is ‘the path of least resistance’, and approaches to facilitating treatment escalation planning in frailty. Conclusion Barriers to treatment escalation planning include a lack of shared understanding of frailty and uncertainty about the future. Emergency decision-making is focussed on survival or risk aversion and patient preferences are rarely considered. To improve planning discussions, we recommend frailty training for non-specialist clinicians, multi-disciplinary support, collaborative working between patients, carers and clinicians as well as broader public engagement.

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Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study

Cited by 8 publications

References 27 publications

GPs’ views on emergency care treatment plans: an online survey

GPs’ views on emergency care treatment plans: an online survey

Patient and relative experiences of the ReSPECT process in the community: an interview-based study

“I’d rather wait and see what’s around the corner”: A multi-perspective qualitative study of treatment escalation planning in frailty

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