Research leading to and evaluating ReSPECT

Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis

Perkins et al, Health Services and Delivery Research, No. 4.11

Identified problems and inconsistencies in considering, discussing and documenting DNACPR, and that DNACPR could be misinterpreted to mean that other, potentially beneficial treatments, should be withheld.

Resuscitation policy should focus on the patient, not the decision 

Fritz et al, BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j813

A summary of reasons why change was needed.

The Universal Form of Treatment Options (UFTO) as an Alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Orders: A Mixed Methods Evaluation of the Effects on Clinical Practice and Patient Care

Fritz et al September 4, 2013

By contextualising a CPR recommendation within overall goals of care, clinicians were more comfortable having conversations with patients, misunderstandings were reduced, and objective preventable harms to patients were significantly reduced.

Development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)

Hawkes et al, Resuscitation. 2020 Mar 1;148:98-107. doi: 10.1016/j.resuscitation.2020.01.003. Epub 2020 Jan 13. PMID: 31945422.  

Building on the above research, and working with stakeholders and patients, with the support of Resuscitation Council UK, the ReSPECT form was developed.

Recommended summary plan for emergency care and treatment: ReSPECT a mixed-methods study

Perkins et al, Southampton (UK): National Institute for Health and Care Research; 2022 Dec. PMID: 36548453.  

This project tracked the early adoption of ReSPECT in NHS hospitals. It found that one in five patients in the hospitals studied had a ReSPECT recommendation.  Patients and family members were involved in most conversations, which focused on recommendations for resuscitation and other emergency treatments.  The best conversations required time and good communication skills.  

A Quantitative and Qualitative Evaluation of the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) Process in Forth Valley Scotland’s first ReSPECT pilot: A Case for Change April 2019

Fielden et al, ReSPECT Report. NHS Forth Valley. April 2019

Main findings

• ReSPECT facilitates person-centred anticipatory care planning and promotes shared decision making which is up to date and useful in an emergency.
• The ReSPECT process improved patient outcomes, particularly for those nearing the end of life.
• A more sustainable electronic and ultimately digital solution for the ReSPECT process is required to support the project both locally and nationally.

Secondary care consultant clinicians' experiences of conducting emergency care and treatment planning conversations in England: an interview-based analysis

Eli et al BMJ Open. 2020 Jan 20;10(1):e031633. 

The management of uncertainty about prognoses and patients' emotional reactions is central to secondary care consultant clinicians' experiences of timing and conducting ReSPECT conversations. 
 

General practitioners' experiences of emergency care and treatment planning in England: a focus group study

Huxley et al, BMC Fam Pract. 2021 Jun 24;22(1):128. doi: 10.1186/s12875-021-01486-w. PMID: 34167478; PMCID: PMC8224258.

Conceptualising ReSPECT as an end-of-life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts the transferability of ReSPECT recommendations to the hospital setting.
 

Implementing and improving the ReSPECT process within medical and orthopaedic departments of a district general hospital

Progress in Palliative Care, (2020) Progress in Palliative Care, 28:4, 254-259, 

Senior consultant engagement was key to providing a cultural shift in early anticipatory care planning which helped to foster an environment of open communication among the team, allowing for more effective recognition of frail or co-morbid patients.