ReSPECT process
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Introduction
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It is an emergency care and treatment plan (ECTP) in which personalised recommendations for future emergency clinical care and treatment are created through discussion between health care professionals and a person (or their legal proxy or those close to them). These recommendations are then documented on a ReSPECT form.[1]
The ReSPECT process is centred around conversations which aim to develop a shared understanding between the healthcare professional and a person about their condition, the outcomes the person values and those they fear and then how treatments and interventions, such as cardiopulmonary resuscitation (CPR) fit into this. It supports the important principle of personalised care.[2]
A person’s ReSPECT form includes recommendations about emergency treatments that could be helpful and should be considered, as well as those not wanted by or that would not work for them. It includes a recommendation about cardiopulmonary resuscitation (CPR), but that may be a recommendation that CPR is attempted, or a recommendation that it is not attempted.
ReSPECT forms are not legally binding but can be used by health care professionals to guide them when providing treatment for the person in a future emergency situation. As the ReSPECT process and form are designed to be recognised across different care settings (for example between hospitals, primary care, ambulance services, or care homes) and to cross geographical boundaries, the person does not have to undertake repeated conversations and discussions.
Development
ReSPECT was developed after attendees at a 2014 summit at the Royal Society of Medicine on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in the UK criticised the variability and problematic practice linked to standalone DNACPR decisions.[3] Development of the ReSPECT process involved a review of literature, a national consultation, interviews with healthcare professionals and members of the public, a workshop with patients and public, and a usability trial.
Usage
The ReSPECT process is used in around 70% of counties in England and in some areas of Scotland. In the UK, 21% of hospitals had adopted ReSPECT by December 2019.[4] ReSPECT is the fastest growing ECTP in the UK, as many hospitals move away from using standalone DNACPR forms.[4]
Evaluation
An evaluation of the use of ReSPECT[4] in hospitals in England, during the early stages of adoption found the following:
- Hospital-based healthcare professionals prioritised ReSPECT conversations with patients whom they identified as terminally ill or anticipated were at imminent risk of deterioration. A move towards a more holistic approach in terms of treatment recommendations and conversations was observed. However, a central component of many conversations focused on situations where CPR attempts were not recommended.
- Emergency care treatment planning conversations are often complex and need to draw together patients' preferences and values within a framework of clinical judgement.
- Conversations were easier for patients, their family, and health care professionals if patients had thought about these things in advance and discussed this with their family.
- Patients (and / or those close the patient) were involved in making most but not all emergency care treatment plans. The ReSPECT supporting materials were rarely used during decision making. Involvement of patients usually focused on asking about their preferences for specific treatments or explaining recommendations. It was rarer for patients to be asked about their values and preferences, and for these to influence recommendations.[5]
- Recommendations on ReSPECT forms completed in hospital sometimes are not helpful when future decisions are made in the community.
- ReSPECT conversations take time to do properly and so may not happen or be done well if there is limited time because of staff shortages or a busy ward environment.
External Links
Resuscitation Council UK ReSPECT process
ReSPECT resources and list of clinical publications
ReSPECT evaluation webpage
References
- ^ Resuscitation Council UK. "ReSPECT for Patients and Carers". Retrieved 30 January 2021.
- ^ Resuscitation Council UK. "The ReSPECT Process: For Health and Care Professionals 2020". Retrieved 11 June 2020.
- ^ Hawkes, C (2020). "Development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)". Resuscitation. 148: 98–107.
- ^ a b c Perkins, GD (2021). "Evaluation of the Recommended Summary Plan for Emergency Care and Treatment". Health Services and Delivery Research.
- ^ Eli, K (2021). "Why, when and how do secondary-care clinicians have emergency care and treatment planning conversations? Qualitative findings from the ReSPECT Evaluation study". Resuscitation.
| This article, ReSPECT process, has recently been created via the Articles for creation process. Please check to see if the reviewer has accidentally left this template after accepting the draft and take appropriate action as necessary.
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