Abstract
BackgroundEmergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.MethodsWe conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. Participants were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis.ResultsGPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a ‘good death’ is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient’s preferences around death, and GPs’ lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings.ConclusionConceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.
Highlights
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an Emergency Care and Treatment Plan (ECTP), developed to integrate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions with discussions about wider goals of care [1, 2]
ECTPs were designed to address concerns identified about the use of standalone DNACPR decisions by Huxley et al BMC Fam Pract (2021) 22:128 contextualising them within broader treatment plans making recommendations for use in future emergency situations
ReSPECT is an end of life care document There was an implicit assumption that ReSPECT was to be used to plan end of life care, and should be used for patients who were “coming to the last 2 or 3 years of their life” (FG5); palliative care patients, frail patients, or patients in the final stages of a chronic illness
Summary
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an Emergency Care and Treatment Plan (ECTP), developed to integrate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions with discussions about wider goals of care [1, 2]. ReSPECT was designed to travel with the patient and be recognised across different care settings It records treatment recommendations discussed and agreed between the patients and their clinicians for a future emergency situation when patients may not have capacity to make decisions for themselves. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their cli‐ nicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface
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