Evaluation of ReSPECT
Research type
Research Study
Full title
A qualitative evaluation of the implementation and use of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in nursing & care homes
IRAS ID
268211
Contact name
Jon Banks
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary
Too few frail and complex patients have advance care plans that describe what should happen in an emergency. This means that clinicians and carers have to make decisions about a person’s best interests and preferences and some very frail patients are resuscitated when they would not wish to be. Many people are also taken to hospital in an emergency when this may not be the most appropriate course of action. They often recover much more slowly in hospital than they would have in more familiar surroundings and in the worst case scenario they may reach the end of their life in a hospital setting rather than in a place of their choosing.
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a process to plan a person’s clinical care in the event of a future emergency when they might be unable to make or express choices. The development of ReSPECT has been supported by the UK Resuscitation Council. The ReSPECT process is being implemented across the West of England with the support of the West of England Academic Health Science Network (AHSN) to encourage people to have conversations about advance care planning in the event of an emergency.
NIHR ARC West in collaboration with the WEAHSN will undertake a qualitative evaluation of the ReSPECT process in care and nursing homes for elderly people in the West of England region. The overall aim of the project is, to understand whether the ReSPECT process offers an effective framework for encouraging and empowering staff to have conversations with patients living in care/ nursing homes about their preferences in the event of a clinical emergency
Summary of Results
Background
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an advance care planning process designed to facilitate discussion and documentation of preferences for care in a medical emergency. Advance care planning is important in residential and nursing homes.
What we did
We explored 16 GPs and 11 care home staff in the West of England experiences of:
supporting, and documenting, conversations about care home residents’ preferences for emergency care situations supporting decision-making in clinical emergencies.
What we found and what this meansWe found that ReSPECT conversations with care home residents enable residents’ to express preferences for care in an emergency in a more holistic and inclusive way than other forms of advance care planning. GPs would tend to create personalised scenarios relating to medical conditions to create meaningful conversations. Care staff played a key role in setting up and facilitating ReSPECT conversations between GPs and residents. Moving from the conversations to completing the ReSPECT form was challenging. Care staff highlighted the difficulties of understanding what had been written on the ReSPECT form and using this information to create clear guidelines for action during a clinical emergency.
Overall, the study highlights the potential benefit of employing a multi-disciplinary team approach to completing ReSPECT so that what goes onto the ReSPECT form can be understood by all the relevant care staff and other health care professionals such as paramedics.
Key Points
ReSPECT is viewed as supporting person-centred conversations about care home resident preferences for emergency care.
Translating preferences into action in emergency situations is a challenge of using ReSPECT in care homes.
A multi-disciplinary team approach, particularly involving care home staff, could support and enhance the ReSPECT process.
Training in completing the process and form could help ensure clear instructions are given in emergencies.REC name
Social Care REC
REC reference
19/IEC08/0049
Date of REC Opinion
14 Jan 2020
REC opinion
Further Information Favourable Opinion