P-26 Junior doctors’ experiences of ReSPECT conversations during COVID-19: results of a service evaluation project

Abstract

<h3>Background</h3> During the COVID-19 pandemic, with limited intensive care resources and an unprecedented number of acutely unwell patients in hospital, conversations about resuscitation and treatment escalation plans became more important than ever. Locally, these decisions are documented using a ReSPECT form. We aimed to explore junior doctors’ experiences of having these conversations with patients and their relatives during the COVID-19 pandemic, in order to identify areas for further training. <h3>Methods</h3> An anonymous mixed-methods questionnaire was distributed to junior doctors across a teaching hospital in the East Midlands. The free-text responses were manually coded and underwent thematic analysis. As this was an internally approved service evaluation project, no ethics committee approval was required. <h3>Results</h3> 14 junior doctors’ responses were included in the final analysis. 93% of respondents had discussed resuscitation or treatment escalation with a patient or relative during the COVID-19 pandemic. Compared to prior to the pandemic, 62% of these respondents felt more confident in their ability to discuss resuscitation, and 77% felt more able to identify a patient who should have a ReSPECT form in place. However, 62% would like more training on how to discuss resuscitation or treatment escalation, and only 52% felt adequately supervised when having these conversations. Thematic analysis revealed the following major themes: challenges of virtual conversations, emotional burden on junior doctors, and unmet training needs. <h3>Conclusion</h3> The findings reveal that junior doctors’ confidence in their own ability to have conversations about resuscitation and treatment escalation has improved since the start of the COVID-19 pandemic. However, there are still significant unmet training needs in this area. The results of this work are informing the development of local educational interventions to address these requirements.