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If you are interested in developing an electronic ReSPECT plan to sit within your patient record system, then please contact us at info@respectprocess.org.uk. All plans developed will need to be submitted for approval before being adopted for use.

The ReSPECT Learning Web-application is no longer available due to technical limitations with the platform. While we work on developing a replacement, please use the ReSPECT Modules (Awareness and Authorship Trainings) on E-learning for Health. You will need to register and then log in to have access. If you have any questions about access, please reach out to the team at E-learning for Health via -lfh.org.uk/.

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Sharing stories relating to the use of ReSPECT will help us to learn from and promote the process. If you have experience of using ReSPECT, either as a patient/carer or as a health care professional, we would love to hear about it. Please get in touch at info@respectprocess.org.uk.

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Introduction: Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a UK advance care planning (ACP) initiative aiming to standardise the process of creating personalised recommendations for a person's clinical care in a future emergency and therefore improve person-focused care. Implementation of the ReSPECT process across a large geographical area, involving both community and secondary care, has not previously been studied. In particular, it not known whether such implementation is associated with any change in outcomes for those patients with a ReSPECT form.Implementation of ReSPECT in the Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG) area overlapped with the first UK COVID-19 wave. It is unclear what impact the pandemic had on the implementation of ReSPECT and if this affected the type of patients who underwent the ReSPECT process, such as those with specific diagnoses or living in care homes. Patterns of clinical recommendations documented on ReSPECT forms during the first year of its implementation may also have changed, particularly with reference to the pandemic.To determine the equity and potential benefits of implementation of the ReSPECT form process in BNSSG and contribute to the ACP evidence base, this study will describe the characteristics of patients in the BNSSG area who had a completed ReSPECT form recorded in their primary care medical records before, during and after the first wave of the COVID-19 pandemic; describe the content of ReSPECT forms; and analyse outcomes for those patients who died with a ReSPECT form.

Methods and analysis: We will perform an observational retrospective study on data, collected from October 2019 for 12 months. Data will be exported from the CCG Public Health Management data resource, a pseudonymised database linking data from organisations providing health and social care to people across BNSSG. Descriptive statistics of sociodemographic and health-related variables for those who completed the ReSPECT process with a clinician and had a documented ReSPECT form in their notes, in addition to their ReSPECT form responses, will be compared between before, during and after first COVID-19 wave groups. Additionally, routinely collected outcomes for patients who died in our study period will be compared between those who completed the ReSPECT process with a community clinician, hospital clinician or not at all. These include emergency department attendances, emergency hospital admissions, community nurse home visits, hospice referrals, anticipatory medication prescribing, place of death and if the patient died in preferred place of death.

Implementation of ReSPECT in the Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG) area overlapped with the first UK COVID-19 wave. It is unclear what impact the pandemic had on the implementation of ReSPECT and if this affected the type of patients who underwent the ReSPECT process, such as those with specific diagnoses or living in care homes. Patterns of clinical recommendations documented on ReSPECT forms during the first year of its implementation may also have changed, particularly with reference to the pandemic.

It should also be considered that irrespective of the pandemic, all published studies on the ReSPECT form have included small samples and the majority have been secondary care orientated. This study is the first to explore the implementation, use and outcomes of all documented ReSPECT forms (from primary and secondary care) for a large patient population, specifically the approximately one million patients served by the BNSSG CCG.

The PHM dataset consists of two tables: attributes and activity. The first table contains information regarding patient characteristics, such as demographic information (age and sex), clinical information (long-term conditions), socioeconomic information (deprivation index), as well as other data like smoking status and social status. The second table contains information regarding patient contacts such as point of delivery (eg, secondary care, inpatient and elective), specialty (eg, dermatology), provider, dates, times and cost. More details of its contents can be found in the Github online repository.28

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, which supports the ReSPECT process, is designed to prompt clinicians to discuss wider emergency treatment options with patients and to structure the documentation of decision-making for greater transparency.

Methods: Following an accountability for reasonableness framework (AFR), we analysed 141 completed ReSPECT forms (versions 1.0 and 2.0), collected from six National Health Service (NHS) hospitals in England during the early adoption of ReSPECT. Structured through an evaluation tool developed for this study, the analysis assessed the extent to which the records reflected consistency, transparency, and ethical justification of decision-making.

Results: Recommendations relating to CPR were consistently recorded on all forms and were contextualised within other treatment recommendations in most forms. The level of detail provided about treatment recommendations varied widely and reasons for treatment recommendations were rarely documented. Patient capacity, patient priorities and preferences, and the involvement of patients/relatives in ReSPECT conversations were recorded in some, but not all, forms. Clinicians almost never documented their weighing of potential burdens and benefits of treatments on the ReSPECT forms.

Conclusion: In most ReSPECT forms, CPR recommendations were captured alongside other treatment recommendations. However, ReSPECT form design and associated training should be modified to address inconsistencies in form completion. These modifications should emphasise the recording of patient values and preferences, assessment of patient capacity, and clinical reasoning processes, thereby putting patient/family involvement at the core of good clinical practice. Version 3.0 of ReSPECT responds to these issues.

A ReSPECT plan is created through conversations between yourself and one or more of the health professionals who are involved with your care. The recommendations should respect both patient preferences and clinical judgement.

The agreed plan is recorded on a ReSPECT form, which is available digitally on the Kent and Medway Care Record (KMCR). If your condition changes, or you change your mind, you can speak to your clinician again, who will update your plan.

Professionals such as ambulance clinicians, out-of-hours doctors, care home staff and hospital staff will be better able to make quick decisions about how best to help you in an emergency if they can refer to your ReSPECT form.

Version 3 of the ReSPECT form is more patient-centred (their circumstances, their understanding and their perspective) than previous versions and contains more prompts for explicit clinical reasoning.

If required the pdf version can then be printed at the practice (or in the future in one of the resilience hubs) to then send on to a patient or Care Home. Alternatively the completed electronic PDF form could be emailed to a Care Home using a secure NHS.net account.

The following two videos are a resource for people with Learning Disabilities to enable them to understand what the ReSPECT process is about, how a summary of the conversation is recorded on the ReSPECT plan and how the information is shared and used.

Please note: If we observe any behaviors that may be a distraction to care, including those outlined above, we will respectfully bring this to your attention. Anyone who continues to exhibit these behaviors may be asked to leave the location and to seek future care elsewhere. This applies to family members and visitors as well as patients unless the patient is receiving emergency care or discharge is believed to be unsafe at the time.

Donations to Hartford HealthCare are managed by the Hartford Hospital Department of Philanthropy, a Connecticut tax-exempt organization under section 501(c)(3) of the IRS code (E.I.N. 06-0646668). For more information, click here.

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