An evaluation of advance care planning during the COVID-19 pandemic: a retrospective review of patient involvement in decision making using routinely collected data from digital ReSPECT records

Abstract

To review advance care planning (ACP) practice during the COVID-19 pandemic, evaluating the number of plans created, patient participation, cardiopulmonary resuscitation recommendations and variation between different population groups. A retrospective analysis and comparison of routinely collected data from electronic recommended summary plan for emergency care and treatment (ReSPECT) records documented in April 2020 and January to December 2019. Electronic ReSPECT documents completed for adult patients at a large, acute hospital trust in the UK. The number of plans created per 1,000 admissions in April 2020 was 333.0% higher than in 2019. A greater proportion of plans created during April 2020 were discussed with the patient and the proportion containing a 'for cardiopulmonary resuscitation' recommendation was higher across all population groups. A greater proportion of plans were created for younger adults and Black and minority ethnic groups during the pandemic. Increased ACP during a crisis can be achieved alongside increased patient participation in decision making. A tool such as ReSPECT that supports recommendations for, as well as limitations on, treatment may have enabled the expansion of ACP observed.