A qualitative interview study of implementing ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) in care and nursing homes: a valuable means of eliciting emergency care preferences?

Conference:

SAPC ASM 2021 - virtual

Talk Code:

3E.1

Presenter:

Jo Kesten

Twitter:

@joannakesten

Co-authors:

Jon Banks1,3, Anne Pullyblank6, Sabi Redwood1,3, Tracey Stone1,3, Heather Brant 1,3, Liz Hill1,3, Mike Bell1, Mary Tutaev4, Louise George5, Emma Redfern5, Hein Le Roux5, Alison Tavaré5, Lucy Pocock6 Hannah Little5

Author institutions:

1NIHR ARC West, 2 NIHR HPRU in Behavioural Science and Evaluation, University of Bristol, 3Population Health Sciences, Bristol Medical School, University of Bristol, 4 Patient and Public Involvement contributor, 5West of England Academic Health Sciences Network, 6Centre for Academic Primary Care, University of Bristol, West of England Patient Safety Collaborative

Problem

Decision making around emergency treatment and end of life care planning is challenging in care and nursing home settings. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form and process is an emergency care treatment plan aiming to facilitate a dialogue and document individuals’ preferences for the location and level of treatment they should receive in a medical emergency, accompanied by appropriate clinical recommendations. ReSPECT has been introduced because forms such as ‘do not attempt cardiopulmonary resuscitation’ (DNACPR), designed to prevent CPR when individuals are near the end of life did not prevent inappropriate health care interventions. This study aimed to understand whether the ReSPECT process encourages and empowers GPs and staff to have, and document, conversations with residents of care and nursing homes about their preferences in the event of a clinical emergency. The study also considered the role of ReSPECT during the COVID-19 pandemic and the experience of conducting these conversations during the pandemic.

Approach

A qualitative interview study with: (a) GPs who provide care to care homes across Gloucestershire and Bristol, North Somerset and South Gloucestershire CCGs; and (b) care home staff and residents who completed or facilitated the completion of ReSPECT forms. Interviews were transcribed, anonymised and analysed thematically.

Findings

Sixteen GPs participated in the interviews and to-date we have interviewed 4 members of staff and 4 residents at 1 care home. GP interviews are complete and care home recruitment is ongoing. We report our preliminary findings from the GP interviews here. GPs saw ReSPECT as supporting and formalising emergency treatment and end of life care planning. The ReSPECT process constituted broad and nuanced discussions, sometimes over several conversations. Capturing these conversations and balancing resident preferences with appropriate clinical recommendations on the ReSPECT form is a complex process. Care home staff play an important role in introducing and supporting the process. Their relationship with residents provides: background information, a conduit for conversation, and a means to support the form being reviewed by a resident. COVID-19 accelerated the rollout of ReSPECT in care and nursing homes but completing the process virtually was challenging, especially when involving residents’ families and required additional support from care homes.

Consequences

The evaluation of ReSPECT in care homes in the West of England demonstrates the potential for ReSPECT to support and formalise conversations about nursing and care home resident preferences and treatment decisions for clinical emergencies and end of life care. Our findings highlight the collaboration between care homes and primary care and the value of involving care staff in the ReSPECT process. Multi-disciplinary collaboration is key to ensuring ReSPECT is implemented and used successfully.

Submitted by:

Jo Kesten

Funding acknowledgement:

This research was jointly funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West (ARC West) at University Hospitals Bristol NHS Foundation Trust and the West of England Academic Health Science Network. The views expressed are those of the authors and not necessarily those of NHS England, NHS Improvement, the NIHR, or the Department of Health and Social Care.