Patients who are frail or have complex needs often don’t have care plans that describe what should happen in an emergency. When these plans don’t exist, clinicians and carers must decide what medical action to take without knowing what the person would have wanted.
This can mean that some patients are resuscitated when they wouldn’t want to be, or they are taken to hospital in an emergency when they would have preferred to stay at home or at their care home. In the worst-case scenario, people may die in hospital rather than in a place of their choosing.
ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a process to plan a person’s clinical care in the event of an emergency when they might be unable to make or express their choices. The process has been developed by the UK Resuscitation Council to encourage people to have conversations about advance care planning. It is being implemented in the West of England with the support of the West of England Academic Health Science Network (AHSN).
With ReSPECT, patients, their families and carers are guided by trained staff through an extended conversation. This can take place over several meetings to allow everyone to be involved. This process results in a completed ReSPECT form that details the person’s wishes for their care, along with clinical recommendations. It will also record a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision if one has been agreed. However, ReSPECT is about wider care preferences and treatment and also applies to patients for whom resuscitation would be preferable.
We want to understand whether ReSPECT offers an effective framework to empower staff to have conversations with people about how they want to be cared for in the event of an emergency. We will also explore and identify barriers to supporting the person’s wishes from an organisational, system and cultural perspective.
Many people are admitted to hospital for end-of-life care even though some would prefer to die in a different setting. This could be their home, care home or hospice. This project aims to evaluate whether the ReSPECT process helps people toreceive end-of-life care in their preferred location.
We will carry out interviews in care and nursing homes, because end of life care planning has been identified as challenging in these settings. We will interview clinical and care staff, care home residents and their families, and analyse data from care homes, GP practices, the ambulance service and Public Health England.
This evaluation will help inform the wider implementation of ReSPECT across the West of England. It will also complement an NIHR funded evaluation of ReSPECT led by the University of Warwick which focuses on the use of ReSPECT for adults admitted to hospital.
The findings from this project will help us understand how ReSPECT is used in care home settings and whether, from the perspectives of staff and residents, it is an acceptable and effective tool to manage the communication of people’s wishes.
- Dr Anne Pullyblank, West of England Patient Safety Collaborative
- Natasha Swinscoe, West of England Academic Health Science Network
- Helen Eddison, West of England Academic Health Science Network
- Emma Redfern, West of England Academic Health Science Network
- Hein Le Roux, West of England Academic Health Science Network
- Alison Tavaré, West of England Academic Health Science Network
- Lucy Pocock, University of Bristol
- Mary Tutaev, Death Café coordinator
- Hannah Little , West of England Academic Health Science Network
- Nathalie Delaney , West of England Academic Health Science Network