Why are some ReSPECT conversations left incomplete? A qualitative case study analysis

Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis

“…There were five from the UK, four from North America and four from Europe. Two study groups accounted for six of the studies ( 19 , 49 , 50 , 51 , 52 , 58 ). Three papers 50 , 51 , 52 derived from the same data set and a fourth paper 55 was a secondary analysis.…”

“…Two study groups accounted for six of the studies ( 19 , 49 , 50 , 51 , 52 , 58 ). Three papers 50 , 51 , 52 derived from the same data set and a fourth paper 55 was a secondary analysis. Of the studies with qualitative components, six observed clinician/patient encounters and interviewed clinicians, one observed clinician/patient encounters and interviewed patients, one interviewed patients only, two interviewed clinicians only, two interviewed patients and clinicians.…”

“… 49 Patient co-morbidities, baseline functioning and age or ‘biological age’ contributed to the medical decision. 49 , 52 , 54 , 59 “If we’ve got a 95-year-old patient who’s bedridden and demented. Well, I’m not going to resuscitate him.…”

“… Primary Six acute NHS trusts Medicine and surgery Consultant, middle grade and junior doctors 49 ReSPECT conversations observed, conducted by 34 clinicians. 31 interviews 32/49 participants were aged 80+ years Ethnographic Observation and interview Not specified Inductive thematic analysis Eli 2022a, England 51 To develop an ethnographic account of how and why clinicians defer and avoid ECTP conversations and how they rationalise these decisions as they happen Secondary of Eli 2021 Six acute NHS trusts Medicine and surgery Consultant, middle grade and junior doctors (observed and interviewed), patients (observed) 34 doctors observed, 32 interviewed; 6 cases selected for in-depth analysis Not specified Ethnographic Observation and interviews Not specified “thick description of each case" Eli 2022b, England 52 Why are some ReSPECT conversations left incomplete? Secondary of Eli 2021 Six acute NHS trusts Medicine and surgery Consultant, middle grade and junior doctors (observed and interviewed), patients (observed) 6 incomplete conversations n/a Case study approach Ethnographic Observation and interviews Not specified Thematic analysis critical realist Escher 2021, Switzerland 53 To determine which factors influence physicians' admission decisions in situations of potentially non-beneficial intensive care Secondary analysis of study examining the triage process Tertiary care centre Internal medicine ICU physicians and internists routinely involved in ICU admission decisions 24 n/a in-depth interviews Convenience and snowball inductive approach to thematic content analysis Fassier 2016, France 54 To explore physician's perceptions of and attitudes towards end-of-life decisions for elderly critically ill patients at the ED-ICU interface Primary Hospital ED, short stay unit, step down unit, medical ICU.…”

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

“…An observation- and interview-based study of ReSPECT conversations in hospital found that conversations could be exploratory or persuasive, with doctors taking varying stances toward the extent to which patients’ and relatives’ preferences should direct the recommendations [ 3 ]. An ethnographic study found that some ReSPECT conversations in hospital were not performed due to time constraints and the sensitivity of timing these conversations, while another study found that, in hospital settings, mismatches between doctors’ and patients’ priorities and understandings led to incomplete ReSPECT conversations [ 4 , 5 ]. In addition, interview and focus group studies found that both hospital-based and primary care doctors viewed ReSPECT as a process that required good rapport and careful negotiation of patients’ and relatives’ emotions [ 6 , 7 ].…”