ReSPECT in Primary Care
Research type
Research Study
Full title
Evaluating the integration of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) into primary care and its impact on patient treatment and care.
IRAS ID
299464
Contact name
Anne Slowther
Contact email
Sponsor organisation
University of Warwick
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
When a person becomes seriously ill health professionals treating them need to make decisions quickly. They may have limited information about the person’s medical history or about their wishes about treatment. To help health care professionals decide what is the best treatment for that person Emergency Care Treatment Plans can be used. These record what the person would or would not want to happen in certain situations. The plans are usually written by the person’s doctor after discussing it with them. One type of plan, called ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is used in many NHS hospitals in the UK. However, it might be better to write these plans when the person is living at home before they are admitted to hospital. ReSPECT forms are now being used by GPs and other primary care staff in the UK. This project plans to study the ReSPECT process in primary care to determine how, when, and why it is used, and what effect it has on patient treatment and care. It will use a mixture of methods for collecting information.
We will interview patients, their families, GPs and care home managers to ask them about their experience of the ReSPECT process. To get a wider range of views, we will also speak to groups of other health professionals, patient organisations and faith leaders, and carry out national surveys of GPs and the general public. The study will also look how at patient records to see how the ResPECT process makes a difference to decisions about medical treatment when a person is seriously ill. The information from these different methods will be brought together at a stakeholder meeting and will be used to work out how the ReSPECT process can work best to improve patient treatment and care.
LAY SUMMARY OF STUDY RESULTS:
ReSPECT is the most common emergency care treatment plan in the UK. At present, ReSPECT is mainly used when health care professionals think that someone is nearing the end of their life.
Health and social care professionals, patients and the public all think that ReSPECT plans are a good idea. When completed well they can help to make sure that treatment and care for a person in an emergency fit with what that person would want to happen. However, only about half of ReSPECT plans that we looked at recorded what the person wanted to happen.
ReSPECT planning takes time to understand what is important to the person and explain possible future emergency situations and possible treatment options, and carefully record all the information. These conversations work best when the person knows and trusts their health care professional. GPs often do not have enough time for these complex conversations.
People need time to prepare for a ReSPECT planning conversation. This is especially true for people with a learning disability. Information about ReSPECT needs to be accessible for everyone.
Imagining what might happen in the future is difficult so it is not always possible to record clear recommendations that cover every situation. Because of this, health care professionals and care home staff sometimes find it difficult to follow ReSPECT recommendations in an emergency. Sometimes they disagree about what should be done. Members of the public thought that it might be difficult to follow recommendations in an emergency and that a plan might be out of date by the time it was needed.
Good emergency treatment planning for people in the community is complicated. We found many good things about ReSPECT but we also found that it doesn’t always work as it should. We think more work needs to be done to improve the process. The most important thing is to make sure that when health care professionals make decisions about treatment for a person in an emergency, they know what is important to the patient and what their preferences are.REC name
London - South East Research Ethics Committee
REC reference
21/LO/0455
Date of REC Opinion
17 Jun 2021
REC opinion
Favourable Opinion